|
|
重症急性胰腺炎诊治研究进展
|
Abstract:
重症急性胰腺炎是急性胰腺炎中病情最危重、死亡率最高的一种类型，常合并多器官衰竭和全身炎症反应综合征，涉及外科、消化内科、急诊科、重症医学科、感染科、介入科、营养科、康复科等多个学科的复杂问题，成为临床疾病救治的巨大挑战。对SAP合并并发症能够早期明确诊断及施加适宜的干预治疗，成为降低患者死亡率的关键。近几年随着基础研究深入和临床实践发展，我国学者结合以往指南及专家共识对SAP的诊治提出了新的推荐意见，本文着重对近年来国内外SAP诊断和治疗方面取得的最新进展进行综述。
Severe acute pancreatitis (severe acute pancreatitis, SAP) is the most severe type of acute pancrea-titis (acute pancreatitis, AP) with the highest mortality rate. Severe acute pancreatitis is often asso-ciated with multiple organ dysfunction syndrome (MODS) and systemic inflammatory response syndrome (SIRS). The treatment of severe acute pancreatitis involves surgery, gastroenterology, emergency department, critical care medicine, infection department, interventional department, nutrition department, rehabilitation department and other disciplines. The above complex prob-lems have become a great challenge for the clinical treatment of severe acute pancreatitis. Early diagnosis of complications associated with SAP and appropriate intervention has become the key to reduce mortality. In recent years, with the deepening of basic research and the development of clinical practice, Chinese scholars have put forward new recommendations for the diagnosis and treatment of SAP based on the previous guidelines and expert consensus. This review focuses on the latest progress in the diagnosis and treatment of SAP at home and abroad in recent years.
| [1] | Yadav, D. and Lowenfels, A.B. (2013) The Epidemiology of Pancreatitis and Pancreatic Cancer. Gastroenterology, 144, 1252-1261. https://doi.org/10.1053/j.gastro.2013.01.068 |
| [2] | 中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南(2021) [J]. 中华消化外科杂志, 2021, 20(7): 730-739. |
| [3] | Zheng, Y., Zhou, Z., Li, H., et al. (2015) A Multicenter Study on Etiology of Acute Pancreatitis in Beijing during 5 Years. Pancreas, 44, 409-414. https://doi.org/10.1097/MPA.0000000000000273 |
| [4] | Boxhoorn, L., Voermans, R.P., Bouwense, S.A., et al. (2020) Acute Pancreatitis. The Lancet, 396, 726-734.
https://doi.org/10.1016/S0140-6736(20)31310-6 |
| [5] | Banks, P.A., Bollen, T.L., Dervenis, C., et al. (2013) Classi-fication of Acute Pancreatitis 2012: Revision of the Atlanta Classification and Definitions by International Consensus. Gut, 62, 102-111.
https://doi.org/10.1136/gutjnl-2012-302779 |
| [6] | Gumaste, V.V., Roditis, N., Mehta, D. and Dave, P.B. (1993) Serum Lipase Levels in Nonpancreatic Abdominal Pain versus Acute Pancreatitis. American Journal of Gastroenterology, 88, 2051-2055. |
| [7] | Balthazar, E.J., Robinson, D.L., Megibow, A.J. and Ranson, J.H. (1990) Acute Pancreatitis: Value of CT in Establishing Prognosis. Radiology, 174, 331-336. https://doi.org/10.1148/radiology.174.2.2296641 |
| [8] | Raghuwanshi, S., Gupta, R., Vyas, M.M. and Sharma, R. (2016) CT Evaluation of Acute Pancreatitis and Its Prognostic Correlation with CT Severity Index. Journal of Clinical and Diagnostic Research, 10, TC06-TC11.
https://doi.org/10.7860/JCDR/2016/19849.7934 |
| [9] | McPherson, S.J., O’Reilly, D.A., Reilly, D.A., et al. (2017) The Use of Imaging in Acute Pancreatitis in United Kingdom Hospitals: Findings from a National Quality of Care Study. The British Journal of Radiology, 90, 1080.
https://doi.org/10.1259/bjr.20170224 |
| [10] | Wan, J., Ouyang, Y., Yu, C., et al. (2018) Comparison of EUS with MRCP in Idiopathic Acute Pancreatitis: A Systematic Review and Metaanalysis. Gastrointestinal Endoscopy, 87, 1180-1188.e9.
https://doi.org/10.1016/j.gie.2017.11.028 |
| [11] | Rau, B.M., Kemppainen, E.A., Gumbs, A.A., et al. (2007) Early Assessment of Pancreatic Infections and Overall Prognosis in Severe Acute Pancreatitis by Procalcitonin (PCT): A Pro-spective International Multicenter Study. Annals of Surgery, 245, 745-754. https://doi.org/10.1097/01.sla.0000252443.22360.46 |
| [12] | 羊琦, 黄宁, 吴万春. 四种评分系统对中重度高脂血症性急性胰腺炎的预测价值[J]. 齐齐哈尔医学院学报, 2021, 42(15): 1307-1310. |
| [13] | Hines, O.J. and Pandol, S.J. (2019) Management of Severe Acute Pancreatitis. BMJ, 367, l6227.
https://doi.org/10.1136/bmj.l6227 |
| [14] | Liu, T., Huang, W., Szatmary, P., et al. (2017) Accuracy of Circulating His Tones in Predicting Persistent Organ Failure and Mortality in Patients with Acute Pancreatitis. British Journal of Surgery, 104, 1215-1225.
https://doi.org/10.1002/bjs.10538 |
| [15] | Bang, J.Y., Wilcox, C.M., Navaneethan, U., et al. (2018) Impact of Dis-connected Pancreatic Duct Syndrome on the Endoscopic Management of Pancreatic Fluid Collections. Annals of Surgery, 267, 561-568.
https://doi.org/10.1097/SLA.0000000000002082 |
| [16] | Vege, S.S., DiMagno, M.J., Forsmark, C.E., et al. (2018) Initial Medical Treatment of Acute Pancreatitis: American Gastroenterological Association Institute Technical Review. Gastroenterology, 154, 1103-1139.
https://doi.org/10.1053/j.gastro.2018.01.031 |
| [17] | Crockett, S.D., Wani, S., Gardner, T.B., et al. (2018) American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroenterology, 154, Article ID: 10961101.
https://doi.org/10.1053/j.gastro.2018.01.032 |
| [18] | Iqbal, U., Anwar, H. and Scribani, M. (2018) Ringer’s Lactate versus Normal Saline in Acute Pancreatitis: A Systematic Review and Meta-Analysis. Journal of Digestive Diseases, 19, 335-341.
https://doi.org/10.1111/1751-2980.12606 |
| [19] | Jabaudon, M., Belhadj-Tahar, N., Rimmelé, T., et al. (2018) Tho-racic Epidural Analgesia and Mortality in Acute Pancreatitis: A Multicenter Propensity Analysis. Critical Care Medicine, 46, e198.
https://doi.org/10.1097/CCM.0000000000002874 |
| [20] | Zhu, Y., Yin, H., Zhang, R., et al. (2016) Nasogastric Nu-trition versus Nasojejunal Nutrition in Patients with Severe Acute Pancreatitis: A Meta-Analysis of Randomized Con-trolled Trials. Gastroenterology Research and Practice, 2016, Article ID: 6430632. https://doi.org/10.1155/2016/6430632 |
| [21] | Endo, A., Shiraishi, A., Fushimi, K., et al. (2018) Comparative Effec-tiveness of Elemental Formula in the Early Enteral Nutrition Management of Acute Pancreatitis: A Retrospective Cohort Study. Annals of Intensive Care, 8, Article No. 69. https://doi.org/10.1186/s13613-018-0414-6 |
| [22] | 时芳, 陆晓燕, 韦瑶. 早期适时肠内营养干预对重症胰腺炎患者机体营养状况及免疫功能的影响[J]. 护理实践与研究, 2022, 19(3): 413-416. |
| [23] | Reuken, P.A., Albig, H., R？del, J., et al. (2018) Fungal Infections in Patients with Infected Pan-creatic Necrosis and Pseudocysts: Risk Factors and Outcome. Pancreas, 47, 92-98. https://doi.org/10.1097/MPA.0000000000000965 |
| [24] | Moggia, E., Koti, R., Belgaumkar, A.P., et al. (2017) Pharmacological Interventions for Acute Pancreatitis. Cochrane Database of Systematic Reviews, 4, CD011384. https://doi.org/10.1002/14651858.CD011384.pub2 |
| [25] | 关万涛. 大承气汤联合中药灌肠治疗重症胰腺炎预后临床观察[J]. 湖北中医药大学学报, 2020, 22(1): 64-67. |
| [26] | Adiamah, A., Psaltis, E., Crook, M., et al. (2018) A Systematic Review of the Epidemiology, Pathophysiology and Current Management of Hyperlipidaemic Pancreatitis. Clinical Nutrition, 37, 1810-1822.
https://doi.org/10.1016/j.clnu.2017.09.028 |
| [27] | Christian, J.B., Arondekar, B., Buysman, E.K., et al. (2012) Clini-cal and Economic Benefits Observed When Follow-Up Triglyceride Levels Are Less than 500 mg/dL in Patients with Severe Hypertriglyceridemia. Journal of Clinical Lipidology, 6, 450-461. https://doi.org/10.1016/j.jacl.2012.08.007 |
| [28] | 刘新生, 冯恩志. CRRT在重症胰腺炎治疗中的应用研究[J]. 西北国防医学杂志, 2017, 38(7): 460-462.
https://doi.org/10.16021/j.cnki.1007-8622.2017.07.012 |
| [29] | Fogel, E.L. and Sherman, S. (2014) ERCP for Gall-stone Pancreatitis. The New England Journal of Medicine, 370, 150-157. https://doi.org/10.1056/NEJMct1208450 |
| [30] | Lepp？niemi, A., Tolonen, M., Tarasconi, A., et al. (2019) 2019 WSES Guidelines for the Management of Severe Acute Pancreatitis. World Journal of Emergency Surgery, 14, Article No. 27. https://doi.org/10.1186/s13017-019-0247-0 |
| [31] | Dubina, E.D., de Virgilio, C., Simms, E.R., et al. (2018) Association of Early vs Delayed Cholecystectomy for Mild Gallstone Pancreatitis with Perioperative Outcomes. JAMA Surgery, 153, Article ID: 10571059.
https://doi.org/10.1001/jamasurg.2018.2614 |
| [32] | Arvanitakis, M., Dumonceau, J.M., Albert, J., et al. (2018) En-doscopic Management of Acute Necrotizing Pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Evi-dence-Based Multidisciplinary Guidelines. Endoscopy, 50, 524-546. https://doi.org/10.1055/a-0588-5365 |
| [33] | Hollemans, R.A., Bakker, O.J., Boermeester, M.A., et al. (2019) Superi-ority of Step-Up Approach vs Open Necrosectomy in Long-Term Followup of Patients with Necrotizing Pancreatitis. Gastroenterology, 156, 1016-1026.
https://doi.org/10.1053/j.gastro.2018.10.045 |
| [34] | van Santvoort, H.C., Besselink, M.G., Bakker, O.J., et al. (2010) A Step-Up Approach or Open Necrosectomy for Necrotizing Pancreatitis. The New England Journal of Medicine, 362, 1491-1502.
https://doi.org/10.1056/NEJMoa0908821 |
| [35] | 郑西, 何文华, 祝荫, 吕农华. 2018年欧洲消化内镜学会急性坏死性胰腺炎内镜治疗多学科循证指南解读[J]. 中华消化内镜杂志, 2019, 36(3): 160-165. |
| [36] | Easler, J., Muddana, V., Furlan, A., et al. (2014) Portosplenomesenteric Venous Thrombosis in Patients with Acute Pancreatitis Is Associated with Pancreatic Necrosis and Usually Has a Benign Course. Clinical Gastroenterology and Hepatology, 12, 854-862. https://doi.org/10.1016/j.cgh.2013.09.068 |
| [37] | Mowery, N.T., Bruns, B.R., MacNew, H.G., et al. (2017) Surgical Management of Pancreatic Necrosis: A Practice Management Guideline from the Eastern Association for the Surgery of Trauma. Journal of Trauma and Acute Care Surgery, 83, 316-327. https://doi.org/10.1097/TA.0000000000001510 |
| [38] | 李少一, 张昆鹏, 甄忠广. 经皮肾镜与腹腔镜手术治疗重症急性胰腺炎并感染性胰腺坏死的临床疗效比较[J]. 中国普通外科杂志, 2020, 29(9): 1112-1118. |
