重症急性胰腺炎腹腔引流时机的临床思考

Clinical considerations on the timing of abdominal drainage in severe acute pancreatitis

  • 摘要: 急性胰腺炎是一种消化道急症,根据修订版亚特兰大分类标准,分为轻症、中重症和重症3种类型,其中重症的病死率较高。早期的急性液体和坏死物积聚,后期的包裹性积液和坏死物积聚以及感染性胰腺坏死是重症急性胰腺炎的常见局部并发症。腹腔引流是治疗的重要组成部分,但其引流时机和引流方式在临床上仍有争议。重症急性胰腺炎的腹腔引流治疗包括急性期腹腔积液及时引流和感染性胰腺坏死的穿刺引流。笔者深入探讨腹腔穿刺引流的时机、方案,总结目前文献、指南和临床实践经验,提出针对不同患者制订个性化穿刺引流方案的必要性。

     

    Abstract: Acute pancreatitis is a digestive emergency. According to the modified Atlanta classification criteria, acute pancreatitis is classified into three types: mild, moderate to severe and severe, in which the severe acute pancreatitis has a higher mortality rate. Early acute fluid and necrotic accumulation, later encapsulated fluid and necrotic accumulation, and infectious pancreatic necrosis are common local complications of severe acute pancreatitis. Abdominal drainage is an important component of treatment, but its timing and method of drainage are still controversial in clinical practice. The abdominal drainage treatment for severe acute pancreatitis includes timely drainage of abdominal fluid during the acute phase and puncture drainage for infectious pancreatic necrosis. The author delves into the timing and drainage plan of abdominal puncture drainage, summarizes current literature, guidelines, and clinical practice experience, and proposes the necessity of developing personalized puncture drainage plans for different patients.

     

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