胆汁转流在急性胰腺炎治疗中的作用和价值

Role and value of bile diversion in the treatment of acute pancreatitis

  • 摘要: 近年来,急性胰腺炎(AP)早期以微创为先导的个体化综合治疗模式已使其病死率显著下降,但总体并发症发生率仍居高不下。因此,研究者也在一直不断探索并完善AP的早期诊治策略。目前,胆囊功能学和形态学的改变已不再单纯局限于胆源性胰腺炎中,胆汁淤积、胆囊肿大、张力增高及胆汁成分显著改变已普遍存在于各种原因引发的AP中,且与患者预后密切相关。在此背景下,笔者提出胆汁转流治疗新理念,即超声引导下胆囊穿刺外引流联合胆汁回输。在实践中可观察到胆汁转流的应用可有效改善AP伴胆囊肿大患者的近期疗效,加速其康复。笔者就胆汁转流在AP治疗中的作用和价值进行阐述,并相信随着基础研究的不断深入,以及临床实践路径和方案的持续优化,胆汁转流有望成为AP综合治疗中的重要环节,从而为AP患者带来更多的生存获益。

     

    Abstract: In recent years, the individualized comprehensive treatment mode led by mini-mally invasive techniques in the early stage of acute pancreatitis (AP) has significantly reduced its mortality rate. However, the overall complication rate remains high. This predicament has been prompting us to continuously explore and improve the early diagnosis and treatment strategies for AP. Changes in the functional and morphological aspects of the gallbladder are no longer confined to biliary pancreatitis alone. Cholestasis, gallbladder enlargement, increased tension, and significant alterations in the composition of bile are commonly observed in patients with AP caused by various factors, and these changes are closely related to the prognosis of the patients. Against this backdrop, the authors propose the new concept of bile diversion treatment, that is, percutaneous transhepatic gallbladder drainage guided by ultrasound combined with bile reinfusion. In practice, it has been observed that the application of bile diversion can effectively improve the short‑term efficacy of AP patients with gallbladder enlargement and accelerate their recovery. The authors elaborate on the role and value of bile diversion in the treatment of AP. It is believed that with the continuous in‑depth development of basic research and the continuous optimization of clinical practice pathways and protocols, bile diversion is expected to become an important part of the comprehensive treatment of AP, thus bringing more survival benefits to AP patients.

     

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