经自然腔道内镜下胰腺包裹性坏死引流清创术*

Endoscopic transmural drainage and necrosectomy of walled-off pancreatic necrosis*

摘要:

感染性胰腺坏死（IPN）是急性胰腺炎（AP）的严重局部并发症，其死亡率达32.0%。目前的共识认为对于怀疑或确诊的IPN，有创的干预治疗（包括经皮引流、内镜或手术）应尽可能推迟至发病4周后进行，使坏死组织液化并形成包裹性坏死（WON）。随着内镜技术发展，经自然腔道（胃或十二指肠）内镜下引流及清创术已被国内外指南推荐为WON的首选方法之一。该文详细阐述了WON的诊断与评估；内镜下引流与清创术的适应证、禁忌证、操作步骤、术后评估和并发症处理,最后介绍了近年内镜引流与清创治疗的研究进展。

Abstract:

Pancreatic necrosis (IPN) is a serious complication of acute pancreatitis (AP), with a mortality reported to be as great as 32.0%. At present, it is considered that patients with proven or suspected infected necrotizing pancreatitis, invasive intervention (i.e. percutaneous catheter drainage, endoscopic transluminal drainage/ necrosectomy, minimally invasive or open necrosectomy) should be delayed where possible until at least 4 weeks after initial presentation to allow the collection to become ‘walled-off’. With the development of endoscopic technology, endoscopic transmural (stomach or duodenum) drainage and necrosectomy has been recommended as one of the preferred methods for walled-off necrosis. This article introduces the diagnosis and evaluation of the walled-off necrosis ; the indications, operation procedures, postoperative evaluation and management of postoperative complications of endoscopic transmural drainage and necrosectomy. At last, the research progress of endoscopic drainage and debridement in recent years was introduced.