CAJ | 학술논문

随着对重症急性胰腺炎(SAP)病理生理学研究的不断深入及大量循证医学证据的不断涌现,强调微创化、损伤控制的创伤递升式分阶段治疗SAP理念已获得大多数指南性文件的肯定与推崇.对于确诊或疑似感染性胰腺坏死患者,先行影像学引导下的经皮穿刺置管引流或内镜下内引流;若有必要,则进一步行内镜下腹膜后入路小切口坏死组织清除术、视频辅助下腹膜后入路坏死组织清除术或内镜下经胃或十二指肠的坏死组织清除术,甚至开放性坏死组织清除术.创伤递升式分阶段治疗SAP在显示其优越的临床意义及卫生经济学价值的同时,仍有一些问题需进一步的探讨与优化.
수착대중증급성이선염(SAP)병리생이학연구적불단심입급대량순증의학증거적불단용현,강조미창화、손상공제적창상체승식분계단치료SAP이념이획득대다수지남성문건적긍정여추숭.대우학진혹의사감염성이선배사환자,선행영상학인도하적경피천자치관인류혹내경하내인류;약유필요,칙진일보행내경하복막후입로소절구배사조직청제술、시빈보조하복막후입로배사조직청제술혹내경하경위혹십이지장적배사조직청제술,심지개방성배사조직청제술.창상체승식분계단치료SAP재현시기우월적림상의의급위생경제학개치적동시,잉유일사문제수진일보적탐토여우화.
Both new insights in the pathophysiology of severe acute pancreatitis (SAP) and upspringing related evidence-based supports prompt the staged step-up approach,which stress emphasis on minimal invasiveness and damage control,to be accepted and advocated by the majority of guidelines.For documented or suspected patients with infected pancreatic necrosis,an imaging-guided percutaneous catheter drainage or an endoscopic transluminal drainage should be initially performed followed by,if necessary,a minimal access retroperitoneal necrosectomy,or a video-assisted retroperitoneal debridement,or an endoscopic transluminal necrosectomy,or an even an open access necrosectomy.The outstanding performance of staged step-up approach in patients with SAP has been justified from both a clinical and a health economic point of view,meanwhile,there are some issues remained to be further elucidated and optimized.