【摘要】 重症急性胰腺炎(SAP)是在临床中较为常见的急腹症、危重症,发生于病程中后期的感染并发症对SAP预后影响极大,且通常难以避免。介绍了胰腺及胰腺外继发感染的发病机制,并总结了近10年关于SAP继发感染的病原菌谱。对目前多项用以预防继发感染的策略进行汇总评价,简要叙述了SAP继发感染的外科干预进展。分析表明,SAP继发感染的发病机制、病原学特征、免疫学特征仍不十分明了,感染的防治策略多种多样,但除早期肠内营养之外,尚无确切有效预防感染的手段。关于经皮穿刺置管引流术时机等问题,或将有结论,外科干预措施在创伤递增法/升阶梯法(STEP-UP法)的理论基础上发展迅速,经内镜STEP-UP法治疗危重SAP患者较常规的STEP-UP法略有优势。更多还原

【Abstract】 Severe acute pancreatitis( SAP) is an acute abdominal disease and a critical illness commonly seen in clinical practice. Infection complications in the middle and late stages of SAP have a great impact on the prognosis of SAP and are often difficult to avoid. This article introduces the pathogenesis of secondary pancreatic and extra-pancreatic infections and summarizes the pathogen spectrum of infections secondary to SAP in the past 10 years. This article also summarizes and evaluates the current strategies for preventing secondary infections and briefly describes the advances in surgical interventions for SAP secondary infections. These analyses show that the pathogenesis,pathogenic features,and immunological features of SAP secondary infection remain unclear. There are various control strategies for such infection,but there are still no effective measures to prevent infection except early enteral nutrition. Conclusions will be achieved on the issues including the timing of percutaneous catheter drainage,and surgical interventions have developed rapidly on the basis of the STEP-UP approach. Endoscopic STEP-UP approach is slightly superior to conventional STEP-UP approach in the treatment of critically ill patients with SAP.更多还原