Abstract:

Interpretation of guidelines for the diagnosis and treatment of acute pancreatitis (2014) - Present status and development actuality of treatment of acute pancreatitis        WANG Chun-you,YANG Ming. Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022,China
Corresponding author: WANG Chun-you，E-mail:chunyouwang52@126.com
Abstract    The "Guidelines for the Diagnosis and Treatment of severe acute pancreatitis" were published by the Pancreatic Surgery Group of Surgery Branch of Chinese Medical Association in 2007, and had had great impact on the  standardized treatment and the improvement of outcome of AP. Recently, tremendous progress has been achieved in the research of acute pancreatitis (AP), which influenced many important aspects of the management of acute pancreatitis. Therefore it is necessary to revise the guideline. And the revised guideline is renamed as "Guidelines for the Diagnosis and Treatment of Acute Pancreatitis (2014)". Referring to the latest international progress, the severity of AP is classified as mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). The definition of SAP or MSAP depends on the duration of organ failure, which is translent(≤48h) in MSAP but is persistent(>48h) in SAP. Based on clinic practices of Chinese group, the dynamic disease process could be divided into three phases. Early stage (acute phase) usually lasts for one to two weeks, and is characterized by systemic inflammatory response syndromes (SIRS) and organ failure, which is the first peak of mortality. Middle stage (evolution phase), after acute phase, has a peripancreatic fluid collection or necrotic collection as the major characteristics. Late stage (infection phase), after the fourth week, could cause the infection of pancreas and peripancreatic necrotic tissues, and is the second peak of mortality. Acute peripancreatic fluid collection (APFC), acute necrotic collection (ANC), walled-off necrosis (WON) together with pancreatic pseudocyst are the local complications. The indications for surgical treatment are infected necrosis and oppression symptom. Surgery should not be operated in sterile necrosis without symptoms. Surgical treatment should be delayed. In patients with infected necrosis, antibiotic and PCD could be the first choice of treatment. Surgical interventions of infected pancreatic necrosis include PCD, endoscopic, minimally invasive surgery (such as small incision surgery, video-assisted surgery) and open surgery (necrosectomy and drainage by the abdominal or retroperitoneal approach). The infected pancreatic necrosis is complex and diverse, rational surgical procedures should be selected separately or jointly considering the condition in individual cases.

Key words: acute pancreatitis, guidelines

摘要：

中华医学会外科学分会胰腺外科学组于2007年颁布的《重症急性胰腺炎诊治指南》对我国急性胰腺炎诊治的规范化及疗效的改善发挥了重要作用。近年来，急性胰腺炎的研究取得了巨大进展，对其诊治的很多重要方面产生了明显的影响。为此，学组对之进行了修订，修订后的指南更名为《急性胰腺炎诊治指南（2014）》。参照国际最新进展，急性胰腺炎依据严重程度分为轻症急性胰腺炎（MAP）、中重症急性胰腺炎（MSAP）和重症急性胰腺炎（SAP）。MSAP与SAP的主要区别在于器官功能衰竭持续的时间不同，MSAP为短暂性（≤48 h），SAP为持续性（>48 h）。按照国内的临床经验，病程分为3期。早期（急性期）：发病1~2周，此期以全身炎症反应综合征（SIRS）和器官功能衰竭为主要表现，此期构成第一个死亡高峰。中期（演进期）：急性期过后，以胰周液体积聚、坏死性液体积聚或包裹性坏死为主要表现。后期（感染期）：发病4周以后，可发生胰腺及胰周坏死组织合并感染，此期构成MSAP/SAP病人的第二个死亡高峰。局部并发症包括急性胰周液体积聚（APFC）、急性坏死物积聚（ANC）、包裹性坏死（WON）及胰腺假性囊肿。外科治疗的指征主要是胰腺局部并发症继发感染或产生压迫症状。无菌性坏死积液无症状者无需手术治疗。手术治疗应遵循延期原则。感染性坏死可先行针对性抗生素治疗及B超或CT导向下经皮穿刺引流（PCD）。胰腺感染性坏死的手术方式可分为PCD、内镜、微创手术（主要包括小切口手术、视频辅助手术）及开放手术（包括经腹或经腹膜后途径的胰腺坏死组织清除并置管引流）。胰腺感染性坏死病情复杂多样，各种手术方式可遵循个体化原则单独或联合应用。

关键词: 急性胰腺炎, 指南