《急性胰腺炎诊治指南(2014版)》热点问题解读

Understanding of the Guidelines for the Diagnosis and Treatment of Acute Pancreatitis (2014 edition): Hot issues of surgical treatment of acute pancreatitis

  • 摘要: 近年来,急性胰腺炎(AP)的研究取得了巨大进展,其诊治的很多重要方面发生了明显的变化。2014年,中华医学会外科学分会胰腺外科学组对我国2007年发布的《重症急性胰腺炎诊治指南》进行了修订。修订后的指南,按严重度将AP分为轻症急性胰腺炎(MAP)、中重症急性胰腺炎(MSAP)和重症急性胰腺炎(SAP)三类,后两者主要区别是MSAP器官功能衰竭持续的时间≤48 h,而SAP>48 h。影像学评估采用改良的CT严重指数(MSCTI)评分。局部并发症包括急性胰周液体积聚(APFC)、急性坏死物积聚(ANC)、包裹性坏死(WON)和假性囊肿。病程分期为早期(急性期)、中期(演进期)和晚期(感染期)。感染性坏死是手术指征,无症状的无菌性坏死无需手术。手术须遵循延迟原则。手术方式包括经皮穿刺引流(PCD)、微创手术及开放手术,这些术式可单独或联合应用。

     

    Abstract: Presently, tremendous progress has been achieved in the research of acute pancreatitis (AP), which lead to significant changes in many important aspects of the diagnosis and treatment for AP. In 2014, the Pancreatic Surgery Group of Surgery Branch of Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Severe Acute Pancreatitis which was published in 2007. In the revised guidelines, the severity of AP is classified as mild acute pancreatitis (MAP), moderately severe acutepancreatitis (MSAP) and severe acute pancreatitis (SAP). The definition of SAP or MSAP depends on the duration of organ failure, which is persistent (>48 hours) in SAP but is transient (≤48 hours) in MSAP. Modified CT severity index (MCTSI) is used as the imaging evaluation. Acute peri pancreatic fluid collection (APFC), acute necrotic collection (ANC), walledoff necrosis (WON) and pancreatic pseudocyst are the local complications. The disease course is divided into 3 stages, including early stage (acute phase), middle stage (evolution phase) and late stage (infection phase). Infected necrosis is an indication for the surgical treatment, but the surgery should not be performed in sterile necrosis. Meanwhile, surgical treatment should follow the delayed principle. Surgical methods that include percutaneous drainage (PCD), minimally invasive surgery and open surgery could be selected separately or jointly.

     

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