Timing of catheter drainage in infected necrotizing pancreatitis
Timing of catheter drainage in infected necrotizing pancreatitis
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DOI：
10.1038/nrgastro.2016.23
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发表时间：
2016-05-01
影响因子：
65.1
通讯作者：
Besselink, Marc G.
中科院分区：
文献类型：
--
作者：
van Grinsven, Janneke;van Santvoort, Hjalmar C.;Besselink, Marc G.
急性胰腺炎是最常见的入院胃肠道指征，感染性胰腺和/或胰腺外坏死是一种潜在的致命并发症。目前对感染性坏死的标准治疗是一种循序渐进的方法，包括导管引流，如有必要，随后进行微创坏死切除术。国际指南建议推迟导管引流，直到达到“壁状坏死”阶段，这一过程通常需要急性胰腺炎发作后4周才能完成。这一建议源于初级外科手术切除的时代。然而，推迟导管引流可能不是必要的，早期发现和随后早期引流感染性坏死可能会改善预后。缺乏强有力的数据和国际专家胰腺病学家之间的共识。未来的临床研究，最好是随机的，应该集中在感染性坏死性胰腺炎患者导管引流的时机上。在这个视角中，我们讨论了感染坏死性胰腺炎患者侵入性治疗中的挑战，重点是导管引流的时机。
Acute pancreatitis is the most common gastrointestinal indication for hospital admission, and infected pancreatic and/or extrapancreatic necrosis is a potentially lethal complication. Current standard treatment of infected necrosis is a step-up approach, consisting of catheter drainage followed, if necessary, by minimally invasive necrosectomy. International guidelines recommend postponing catheter drainage until the stage of 'walled-off necrosis' has been reached, a process that typically takes 4 weeks after onset of acute pancreatitis. This recommendation stems from the era of primary surgical necrosectomy. However, postponement of catheter drainage might not be necessary, and earlier detection and subsequent earlier drainage of infected necrosis could improve outcome. Strong data and consensus among international expert pancreatologists are lacking. Future clinical, preferably randomized, studies should focus on timing of catheter drainage in patients with infected necrotizing pancreatitis. In this Perspectives, we discuss challenges in the invasive treatment of patients with infected necrotizing pancreatitis, focusing on timing of catheter drainage.