Surgical Treatment of Acute Pancreatitis

急性胰臟炎的外科治療

黃燦龍(Tsann-Long Hwang)

《Formosan Journal of Surgery》 42卷1期 (2009/02) Pp. 7-12

https://doi.org/10.29833/FJS.200902.0002

摘要

急性胰臟炎的病例在急診或住院病患中並不少見，其嚴重度的表現可以從輕微型的短期間復原，至嚴重型的多器官衰竭或敗血症而死亡。嚴重型的急性胰臟炎病患有一半的死亡率是發生於的疾病發生後的十四天內，大多數是因多器官衰竭；至於其他一半的死亡則是因感染及敗血症所致。近年來治療嚴重型敗血症的原則，已經從早期的外科開刀轉變成積極的加護病房救治。外科治療通常只有在晚期有腹腔內感染的證據時才考慮，這時的清創術主要是移除胰臟或胰臟周圍受感染的壞死組織。由於近年來放射線影像、放射治療技術、以及微創外科手術的進步，外科治療的方法也有很大的改變。這些方法包括內視鏡逆行性膽胰管攝影及乳頭括約肌切開術、以細針抽吸胰臟周圍液體來驗證是否受到細菌感染、經內視鏡引流胰臟周圍液體、假性囊腫或是膿瘍、以及經動脈栓塞併發的嚴重內出血等步驟，均是已經被常引用爲診斷或治療胰臟炎的標準選用方法。由於放射線治療以及微創手術的進步，這些方法也常被用於已經有感染的胰臟壞死組織而不宜接受開腹手術的危險病患。我們的結論是，嚴重型的急性胰臟炎常併有很多內科性的嚴重問題，有效的控制早期的多器官衰竭以及積極的處理後來的胰臟或胰臟周圍的感染，將可大幅降低此類病患的死亡率。

並列摘要

Acute pancreatitis is a common disease ranging in severity from a mild form to multiple organ failure and sepsis. Approximately half of death due to severe acute pancreatitis occur within 14 days and most are due to multiple organ failure. The late deaths are mostly due to infected necrosis. Treatment of severe acute pancreatitis has shifted from early surgical intervention to aggressive intensive care in recent years. The principle of therapy is mostly conservative in the early phase, and surgery is usually considered in the later phase of disease. Surgical debridement is indicated for removal of infected pancreatic and peri-pancreatic necrosis. With advances in radiological imaging, interventional radiology, and other minimal surgical access procedures, the management of many surgical conditions has changed. Several interventional techniques, including endoscopic retrograde cholangiopancreatography and endoscopic papillotomy , fine needle aspiration for bacteriology, percutaneous or endoscopic drainage of peri-pancreatic fluid collections, pseudocysts, and abscesses, as well as selective transarterial catheter embolization for associated active bleeding have been well established as diagnostic and therapeutic standards in the management of acute pancreatitis. With technical improvements in interventional therapy and minimally invasive surgery, even infected pancreatic necrosis has successfully been treated in selected patients. The minimally invasive endoscopic surgery and interventional therapy for infected necrosis should be limited to specific indications in patients who are critically ill and unsuitable for surgical laparotomy. The conclusion is that severe acute pancreatitis remains a serious medical problem, and the effective control of early multiple organ failure and treatment of systemic complications associated with infected necrosis require innovative strategies.

並列關鍵字

acute pancreatitis ； necrosectomy ； minimally invasive surgery ； interventional therapy ； multiple organ failure