Abstract: Key points of open surgery for infected pancreatic necrosis in severe acute pancreatitis        TONG Zhi-hui, LI Wei-qin, LI Jie-shou. Severe Acute Pancreatitis Treatment Center, Jinling Hospital, Medical School of Nanjing University, The Second Clinical College, Medical School of Southeast University, General Hospital of Eastern Theater Command,Jinling Clinical Medical College of Nanjing Medical University， Nanjing 210002, China
Corresponding author: LI Wei-qin, E-mail: liweiqindr@vip.163.com 
Abstract    Infected pancreatic necrosis (IPN) is a bottleneck problem in the treatment of severe acute pancreatitis (SAP) .In recent years, minimally invasive drainage has become the primary choice of treatment for IPN, but open surgery remains an important part of the new "step-up" treatment strategy. Under the new treatment strategy, not only the indications and timing of open surgery should be understood and changed, but also the operation process of open surgery should keep pace with the Times .Therefore, we summarized the key points of open -surgery under the new treatment strategy, and suggested following the three "not-to-do"s: (1) Not to involve the infracolonic compartment in the surgery; (2) No add-on surgery when doing open surgery, simplify the surgery; (3) Not to pursue complete necrosectomy during the first surgery.

Key words: severe acute pancreatitis, infected pancreatic necrosis, open surgery

摘要： 胰腺坏死组织感染（IPN）是目前重症急性胰腺炎（SAP）治疗的瓶颈问题。近年来，微创引流已成为IPN治疗的首选，但开放手术仍然是“step-up”治疗模式的重要组成部分。在新的治疗模式下，不仅开放手术的指征和时机应有新的认识和变化，开放手术的操作过程也应与时俱进。新的治疗模式下IPN开放手术建议遵循“三个尽量不”原则：（1）尽量不干扰结肠下区腹膜腔。（2）尽量不做附加手术，简化手术操作。（3）尽量不指望首次手术完全清除干净。

关键词: 重症急性胰腺炎, 胰腺坏死组织感染, 开放手术