感染性胰腺坏死的外科诊治
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作者单位:

1.首都医科大学宣武医院 普通外科,北京100053;2.首都医科大学急性胰腺炎临床诊疗与研究中心,北京100053

作者简介:

李非,首都医科大学宣武医院主任医师,主要从事胃肠、胰腺疾病方面的研究。

基金项目:

北京科技计划基金资助项目(Z201100005520090)。


Surgical management and treatment of infected pancreatic necrosis
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Affiliation:

1.Department of General Surgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China;2.Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing 100053, China

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    摘要:

    急性胰腺炎是消化系统常见的急腹症之一,且其发病率有逐年上升的趋势。尽管约80%的病例为不伴有局部并发症的轻症患者,但仍有部分患者在病程后期出现胰腺假性囊肿、包裹性坏死等局部并发症,其中以感染性胰腺坏死(IPN)最为严重,病死率可达30%。近年来,以微创外科为核心的治疗方式取得了较好疗效;最新的几项临床试验亦为IPN的外科诊治提供了实质性的新见解。但值得注意的是,IPN具有个体差异大、治疗过程复杂等特点。因此,有必要讨论IPN的外科治疗策略,为临床医师在进行相关处理时提供一定的参考。

    Abstract:

    Acute pancreatitis is one of the common acute abdominal conditions in the digestive system, and its incidence is on the rise. Although approximately 80% of cases involve mild patients without local complications, some patients develop local complications in the later stages of the disease, such as pancreatic pseudocysts and walled-off necrosis. Among these, infected pancreatic necrosis (IPN) is the most severe, with a mortality rate of up to 30%. In recent years, treatment approaches centered around minimally invasive surgery have achieved promising results; several recent clinical trials have also provided substantial new insights into the surgical diagnosis and treatment of IPN. However, it is worth noting that IPN exhibits considerable individual variability and complex treatment processes. Therefore, it is necessary to discuss surgical treatment strategies for IPN to offer clinical practitioners a reference for relevant management.

    图1 IPN的积液分布CT图像(白色箭头表示感染区域) A:Ⅰ区(胰周区域)横切面;B:Ⅲ区(右侧腹膜后区域)横切面;C:Ⅰ+Ⅱa区(胰周区域+左侧腹膜后区域,但未累及盆腔)横切面;D:Ⅰ区(胰周区域)冠状面;E:Ⅲ区(右侧腹膜后区域)冠状面;F:Ⅰ+Ⅱa区(胰周区域+左侧腹膜后区域,但未累及盆腔)冠状面Fig.1 CT images of fluid distribution in IPN (white arrows showing the infected areas) A: Transverse view of zone I (peripancreatic area); B: Transverse view of zone Ⅲ (right retroperitoneal area); C: Transverse view of zone I+IIa (peripancreatic area and left retroperitoneal area, but not involving the pelvis); D: Coronal view of zone I (peripancreatic area); E: Coronal view of zone Ⅲ (right retroperitoneal area); F: Coronal view of zone I+IIa (peripancreatic area and left retroperitoneal area, but not involving the pelvis)
    图2 IPN的外科干预流程Fig.2 Surgical intervention procedure of IPN
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李非,黄铂涵.感染性胰腺坏死的外科诊治[J].中国普通外科杂志,2024,33(9):1385-1391.
DOI:10.7659/j. issn.1005-6947.2024.09.004

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  • 收稿日期:2024-08-09
  • 最后修改日期:2024-09-19
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  • 在线发布日期: 2024-10-12