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腹腔穿刺引流治疗急性重症胰腺炎的研究进展
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Abstract:
本综述系统探讨了腹腔穿刺引流(Abdominal Paracentesis Drainage, APD)在重症急性胰腺炎(Severe Acute Pancreatitis, SAP)治疗中的临床应用价值及其疗效。SAP作为一种危重急症，具有较高的致死率和多种并发症风险。APD作为一种微创治疗技术，其主要作用机制是通过清除胰腺炎相关性腹腔积液(Pancreatitis Associated Abdominal Fluid, PAAF)中的炎性因子和胰酶等有害物质，从而有效缓解全身炎症反应综合征(Systemic Inflammatory Response Syndrome, SIRS)的临床症状。这一治疗方法的创新性在于其能够直接针对SAP病理生理过程中的关键环节进行干预，为改善患者预后提供了新的治疗思路。本文系统回顾了现有关于APD在SAP治疗中的研究，分析了APD的作用机制、临床实施时机、疗效及安全性。通过汇总大量临床研究数据，我们发现APD能够显著改善SAP患者的临床结局，降低并发症发生率，并减少住院时间和医疗费用。然而，APD的具体应用标准和操作规范尚未达成一致，不同研究在最佳实施时机和长期疗效方面存在一定差异。综上所述，APD在SAP治疗中展示出良好的临床前景，但仍需进一步的大规模随机对照试验来验证其效果和安全性。未来的研究应重点关注APD的优化实施策略，以期为SAP患者提供更加有效和安全的治疗方案。
This review systematically investigates the clinical value and efficacy of Abdominal Paracentesis Drainage (APD) in the treatment of Severe Acute Pancreatitis (SAP), a critical emergency with high lethality and multiple complication risks. As a minimally invasive therapeutic technique, the main mechanism of APD is to remove the inflammatory factors and pancreatic enzymes and other harmful substances in Pancreatitis Associated Abdominal Fluid (PAAF), thus effectively relieving Systemic Inflammatory Response Syndrome (SIRS). The innovation of this treatment is that it can directly target the key links in the pathophysiological process of SAP, which provides a new therapeutic idea to improve the prognosis of patients. We systematically reviewed studies on APD for treating SAP, analyzing its mechanism of action, clinical implementation timing, efficacy, and safety. By pooling data from numerous clinical studies, we found that APD significantly improves clinical outcomes, reduces complication rates, and decreases hospitalization length and medical costs for SAP patients. However, there is no consensus on specific criteria for APD, and studies differ on its optimal timing and long-term efficacy. In summary, APD shows promise in treating SAP, but further large-scale randomized controlled trials are needed to verify its efficacy and safety. Future studies should focus on optimizing APD implementation strategies to provide more effective and safe treatment options for SAP patients.
| [1] | Foglio, E.J. and Gorelick, F. (2015) Abdominal Paracentesis Drainage. Journal of Clinical Gastroenterology, 49, 717-719. https://doi.org/10.1097/mcg.0000000000000387 |
| [2] | Wen, Y., Zhuo, W., Liang, H., Huang, Z., Cheng, L., Tian, F., et al. (2023) Abdominal Paracentesis Drainage Improves Outcome of Acute Pancreatitis Complicated with Intra-Abdominal Hypertension in Early Phase. The American Journal of the Medical Sciences, 365, 48-55. https://doi.org/10.1016/j.amjms.2022.08.013 |
| [3] | Li, H., Wu, Y., Xu, C., An, H., Guo, C. and Cui, H. (2018) Early Ultrasound-Guided Percutaneous Catheter Drainage in the Treatment of Severe Acute Pancreatitis with Acute Fluid Accumulation. Experimental and Therapeutic Medicine, 16, 1753-1757. https://doi.org/10.3892/etm.2018.6398 |
| [4] | 洪育蒲, 余佳, 石乔, 等. 急性胰腺炎腺泡细胞损伤机制研究进展[J]. 中国普通外科杂志, 2019, 28(12): 1541-1546. |
| [5] | Liu, R., Wen, Y., Sun, H., Liu, C., Zhang, Y., Yang, Y., et al. (2018) Abdominal Paracentesis Drainage Ameliorates Severe Acute Pancreatitis in Rats by Regulating the Polarization of Peritoneal Macrophages. World Journal of Gastroenterology, 24, 5131-5143. https://doi.org/10.3748/wjg.v24.i45.5131 |
| [6] | Yuan, X., Luo, C., Wu, J., Li, W., Guo, X., Li, S., et al. (2021) Abdominal Paracentesis Drainage Attenuates Intestinal Mucosal Barrier Damage through Macrophage Polarization in Severe Acute Pancreatitis. Experimental Biology and Medicine, 246, 2029-2038. https://doi.org/10.1177/15353702211015144 |
| [7] | Huang, S., Wen, Y., Sun, H., Deng, J., Zhang, Y., Huang, Q., et al. (2021) Abdominal Paracentesis Drainage Attenuates Intestinal Inflammation in Rats with Severe Acute Pancreatitis by Inhibiting the HMGB1-Mediated TLR4 Signaling Pathway. World Journal of Gastroenterology, 27, 815-834. https://doi.org/10.3748/wjg.v27.i9.815 |
| [8] | Wen, Y., Sun, H., Tan, Z., Liu, R., Huang, S., Chen, G., et al. (2020) Abdominal Paracentesis Drainage Ameliorates Myocardial Injury in Severe Experimental Pancreatitis Rats through Suppressing Oxidative Stress. World Journal of Gastroenterology, 26, 35-54. https://doi.org/10.3748/wjg.v26.i1.35 |
| [9] | Luo, C., Huang, Q., Yuan, X., Yang, Y., Wang, B., Huang, Z., et al. (2020) Abdominal Paracentesis Drainage Attenuates Severe Acute Pancreatitis by Enhancing Cell Apoptosis via PI3K/AKT Signaling Pathway. Apoptosis, 25, 290-303. https://doi.org/10.1007/s10495-020-01597-2 |
| [10] | Filomeni, G., De Zio, D. and Cecconi, F. (2015) Oxidative Stress and Autophagy: The Clash between Damage and Metabolic Needs. Cell Death & Differentiation, 22, 377-388. https://doi.org/10.1038/cdd.2014.150 |
| [11] | 卢一琛, 吴俊, 蒋文, 等. 腹腔穿刺引流术通过激活Nrf-2/HO-1通路和抑制自噬减轻大鼠重症急性胰腺炎[J]. 南方医科大学学报, 2022, 42(4): 561-567. |
| [12] | Huang, Z., Yu, S., Liang, H., Zhou, J., Yan, H., Chen, T., et al. (2016) Outcome Benefit of Abdominal Paracentesis Drainage for Severe Acute Pancreatitis Patients with Serum Triglyceride Elevation by Decreasing Serum Lipid Metabolites. Lipids in Health and Disease, 15, Article No. 110. https://doi.org/10.1186/s12944-016-0276-6 |
| [13] | Harvey, J.J., Prentice, R. and George, J. (2022) Diagnostic and Therapeutic Abdominal Paracentesis. Medical Journal of Australia, 218, 18-21. https://doi.org/10.5694/mja2.51795 |
| [14] | Jia, Y., Ding, Y., Mei, W., Xue, Z., Zheng, Z., Qu, Y., et al. (2021) Anterior Abdominal Abscess—A Rare Manifestation of Severe Acute Pancreatitis: A Case Report. World Journal of Clinical Cases, 9, 9218-9227. https://doi.org/10.12998/wjcc.v9.i30.9218 |
| [15] | Huang, J., Li, L., Chen, Y., Mao, E. and Qu, H. (2023) Early Short-Term Abdominal Paracentesis Drainage in Moderately Severe and Severe Acute Pancreatitis with Pelvic Ascites. BMC Surgery, 23, Article No. 363. https://doi.org/10.1186/s12893-023-02269-z |
| [16] | Liu, W., Ren, L., Chen, T., Liu, L., Jiang, J., Wang, T., et al. (2015) Abdominal Paracentesis Drainage Ahead of Percutaneous Catheter Drainage Benefits Patients Attacked by Acute Pancreatitis with Fluid Collections. A Retrospective Clinical Cohort Study. Critical Care Medicine, 43, 109-119. https://doi.org/10.1097/ccm.0000000000000606 |
| [17] | Gou, S., Yang, C., Yin, T., Liu, T., Wu, H., Xiong, J., et al. (2015) Percutaneous Catheter Drainage of Pancreatitis-Associated Ascitic Fluid in Early-Stage Severe Acute Pancreatitis. Pancreas, 44, 1161-1162. https://doi.org/10.1097/mpa.0000000000000397 |
| [18] | Zerem, E., Kurtcehajic, A., Kunosić, S., Zerem Malkočević, D. and Zerem, O. (2023) Current Trends in Acute Pancreatitis: Diagnostic and Therapeutic Challenges. World Journal of Gastroenterology, 29, 2747-2763. https://doi.org/10.3748/wjg.v29.i18.2747 |
| [19] | Chen, R., Chen, H., Li, R. and Lu, H. (2024) Different Timing for Abdominal Paracentesis Catheter Placement and Drainage in Severe Acute Pancreatitis Complicated by Intra-Abdominal Fluid Accumulation. World Journal of Gastrointestinal Surgery, 16, 134-142. https://doi.org/10.4240/wjgs.v16.i1.134 |
| [20] | Liu, W., Wang, T., Yan, H., Chen, T., Xu, C., Ye, P., et al. (2015) Predictors of Percutaneous Catheter Drainage (PCD) after Abdominal Paracentesis Drainage (APD) in Patients with Moderately Severe or Severe Acute Pancreatitis along with Fluid Collections. PLOS ONE, 10, e0115348. https://doi.org/10.1371/journal.pone.0115348 |
| [21] | Zerem, E., Kunosić, S., Zerem, D., et al. (2020) Benefits of Abdominal Paracentesis Drainage Performed Ahead of Percutaneous Catheter Drainage as a Modification of the Step-Up Approach in Acute Pancreatitis with Fluid Collections. Acta Gastro-Enterologica Belgica, 83, 285-293. |
| [22] | Liu, L., Yan, H., Liu, W., Cui, J., Wang, T., Dai, R., et al. (2015) Abdominal Paracentesis Drainage Does Not Increase Infection in Severe Acute Pancreatitis. Journal of Clinical Gastroenterology, 49, 757-763. https://doi.org/10.1097/mcg.0000000000000358 |
| [23] | Liu, N., Wan, Y., Tong, Y., He, J., Xu, S., Hu, X., et al. (2023) A Clinic-Radiomics Model for Predicting the Incidence of Persistent Organ Failure in Patients with Acute Necrotizing Pancreatitis. Gastroenterology Research and Practice, 2023, Article 2831024. https://doi.org/10.1155/2023/2831024 |
| [24] | Gillies, R.J. and Schabath, M.B. (2020) Radiomics Improves Cancer Screening and Early Detection. Cancer Epidemiology, Biomarkers & Prevention, 29, 2556-2567. https://doi.org/10.1158/1055-9965.epi-20-0075 |
| [25] | Huang, H., Chen, W., Tang, G., Liang, Z., Qin, M., Qin, M., et al. (2019) Optimal Timing of Contrast-Enhanced Computed Tomography in an Evaluation of Severe Acute Pancreatitis-Associated Complications. Experimental and Therapeutic Medicine, 18, 1029-1038. https://doi.org/10.3892/etm.2019.7700 |
| [26] | Zerem, D., Zerema, O. and Zerem, E. (2017) Role of Clinical, Biochemical, and Imaging Parameters in Predicting the Severity of Acute Pancreatitis. Euroasian Journal of Hepato-Gastroenterology, 7, 1-5. https://doi.org/10.5005/jp-journals-10018-1202 |
| [27] | Hu, Y., Liu, N., Tang, L., Liu, Q., Pan, K., Lei, L., et al. (2022) Three-Dimensional Radiomics Features of Magnetic Resonance T2-Weighted Imaging Combined with Clinical Characteristics to Predict the Recurrence of Acute Pancreatitis. Frontiers in Medicine, 9, Article 777368. https://doi.org/10.3389/fmed.2022.777368 |
| [28] | Xue, M., Lin, S., Xie, D., Wang, H., Gao, Q., Zou, L., et al. (2023) The Value of CT-Based Radiomics in Predicting the Prognosis of Acute Pancreatitis. Frontiers in Medicine, 10, Article 1289295. https://doi.org/10.3389/fmed.2023.1289295 |
| [29] | Huang, Y. and Badurdeen, D.S. (2023) Acute Pancreatitis Review. The Turkish Journal of Gastroenterology, 34, 795-801. https://doi.org/10.5152/tjg.2023.23175 |
| [30] | Jaworek, J. (2014) Hormonal Protection in Acute Pancreatitis by Ghrelin, Leptin and Melatonin. World Journal of Gastroenterology, 20, 16902-16912. https://doi.org/10.3748/wjg.v20.i45.16902 |
| [31] | Tozlu, M., Kayar, Y., Ince, A.T., Baysal, B. and Senturk, H. (2020) Low Molecular Weight Heparin Treatment of Acute Moderate and Severe Pancreatitis: A Randomized, Controlled, Open-Label Study. The Turkish Journal of Gastroenterology, 30, 81-87. https://doi.org/10.5152/tjg.2018.18583 |
| [32] | Liu, Q., Zhu, X. and Guo, S. (2024) From Pancreas to Lungs: The Role of Immune Cells in Severe Acute Pancreatitis and Acute Lung Injury. Immunity, Inflammation and Disease, 12, e1351. https://doi.org/10.1002/iid3.1351 |
| [33] | Zhou, Q., Tao, X., Xia, S., Guo, F., Pan, C., Xiang, H., et al. (2020) T Lymphocytes: A Promising Immunotherapeutic Target for Pancreatitis and Pancreatic Cancer? Frontiers in Oncology, 10, Article 382. https://doi.org/10.3389/fonc.2020.00382 |
| [34] | Kremer, L., Taleb, O., Boehm, N., Mensah-Nyagan, A.G., Trifilieff, E., de Seze, J., et al. (2019) FTY720 Controls Disease Severity and Attenuates Sciatic Nerve Damage in Chronic Experimental Autoimmune Neuritis. Journal of Neuroinflammation, 16, Article No. 54. https://doi.org/10.1186/s12974-019-1441-4 |
| [35] | Guo, F., Lu, Y., Du, L., Guo, X., Xie, J. and Cai, X. (2024) ACLS4 Could Be a Potential Therapeutic Target for Severe Acute Pancreatitis. Scientific Reports, 14, Article No. 13457. https://doi.org/10.1038/s41598-024-63898-9 |
| [36] | Heckler, M., Hackert, T., Hu, K., Halloran, C.M., Büchler, M.W. and Neoptolemos, J.P. (2021) Severe Acute Pancreatitis: Surgical Indications and Treatment. Langenbeck’s Archives of Surgery, 406, 521-535. https://doi.org/10.1007/s00423-020-01944-6 |
| [37] | Götzinger, P., Sautner, T., Kriwanek, S., Beckerhinn, P., Barlan, M., Armbruster, C., et al. (2002) Surgical Treatment for Severe Acute Pancreatitis: Extent and Surgical Control of Necrosis Determine Outcome. World Journal of Surgery, 26, 474-478. https://doi.org/10.1007/s00268-001-0252-8 |
| [38] | Baron, T.H., DiMaio, C.J., Wang, A.Y. and Morgan, K.A. (2020) American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology, 158, 67-75.E1. https://doi.org/10.1053/j.gastro.2019.07.064 |
| [39] | González-Haba Ruiz, M., Betés Ibáñez, M.T., Martínez Moreno, B., Repiso Ortega, A., de la Serna Higuera, C., Iglesias García, J., et al. (2024) Endoscopic Management of Pancreatic Collections. Endoscopic Ultrasound Group from the Spanish Society of Digestive Endoscopy (GSEED-USE) Clinical Guidelines. Revista Española de Enfermedades Digestivas, 116, 423-437. https://doi.org/10.17235/reed.2024.10276/2024 |
| [40] | Ma, Y., Ong, F., Hew, S., Swan, M., Devonshire, D. and Croagh, D. (2024) Repetitive Endoscopic Drainage as Initial Intervention Is Safe and Effective for Early Treatment of Pancreatic Necrotic Collections. ANZ Journal of Surgery, 94, 881-887. https://doi.org/10.1111/ans.18852 |
| [41] | Trikudanathan, G., Tawfik, P., Amateau, S.K., MBBS, S.M., Arain, M., Attam, R., et al. (2018) Early (<4 Weeks) versus Standard (≥ 4 Weeks) Endoscopically Centered Step-Up Interventions for Necrotizing Pancreatitis. The American Journal of Gastroenterology, 113, 1550-1558. https://doi.org/10.1038/s41395-018-0232-3 |
| [42] | Zerem, E. (2014) Treatment of Severe Acute Pancreatitis and Its Complications. World Journal of Gastroenterology, 20, 13879-13892. https://doi.org/10.3748/wjg.v20.i38.13879 |
| [43] | Shou, C., Sun, Y., Zhang, Q., Zhang, W., Yan, Q., Xu, T., et al. (2024) S100A9 Inhibition Mitigates Acute Pancreatitis by Suppressing RAGE Expression and Subsequently Ameliorating Inflammation. Inflammation. https://doi.org/10.1007/s10753-024-02194-0 |
| [44] | Lu, Z., Zhu, X., Hua, T., Zhang, J., Xiao, W., Jia, D., et al. (2021) Efficacy and Safety of Abdominal Paracentesis Drainage on Patients with Acute Pancreatitis: A Systematic Review and Meta-analysis. BMJ Open, 11, e045031. https://doi.org/10.1136/bmjopen-2020-045031 |
| [45] | Zerem, E., Imamovic, G., Omerović, S. and Imširović, B. (2009) Randomized Controlled Trial on Sterile Fluid Collections Management in Acute Pancreatitis: Should They Be Removed? Surgical Endoscopy, 23, 2770-2777. https://doi.org/10.1007/s00464-009-0487-2 |
| [46] | Formanchuk, T., Lapshyn, H., Voznyuk, O., Formanchuk, A. and Zhmur, A. (2021) Percutaneous Ultrasound-Guided Puncture and Catheter Drainage Methods in the Treatment of Fluid Collections Following Acute Pancreatitis. Wiadomości Lekarskie, 74, 1794-1799. https://doi.org/10.36740/wlek202108103 |
