【摘要】 在重症急性胰腺炎(severe acute pancreatitis,SAP)的病程后期,相当比例的患者会发展为感染性胰腺坏死(infected pancreatic necrosis,IPN),或称感染性坏死性胰腺炎(infected necrotizing pancreatitis,INP),这些患者的病死率极高。而针对INP的治疗是十分棘手的难题。过去十年,胰腺外科专家提出了"外科逐级疗法(surgical step-up therapy)",这一观念为改善患者预后,减少患者开放手术创伤及减轻感染与炎症程度等提供了许多新的方法与思路。尽管如此,如何进一步改善INP患者的预后与生存质量,如何选择逐级疗法中的治疗策略及各种干预手段的介入时机等问题仍然没有得到充分的解答;随着内镜技术的发展,内镜逐级疗法与外科逐级疗法在INP患者治疗中孰优孰劣,也成为近年来讨论的热点话题。文章旨在综述INP外科逐级疗法的策略及各种干预手段的发展现状,同时针对外科与内镜治疗的特点,总结INP治疗的现状并展望其发展前景。更多还原

【Abstract】 During the late course of severe acute pancreatitis(SAP),a considerable proportion of patients will develop infected pancreatic necrosis(IPN),with the extremely high mortality rate.The treatment of infected necrotizing pancreatitis(INP) remains a very difficult problem in the past few decades.In the past ten years,pancreatologists have proposed a "surgical step-up therapy" strategy.This concept provided many new methods for improving the prognosis of patients,reducing the trauma of patients undergoing open surgery,and decreasing the degree of infection and inflammation.Nevertheless,how to further improve the prognosis and life quality of INP patients,how to choose treatment strategy in step-up therapy and what is the timing of intervention for different methods,these questions are still unclear.In the meantime,with the rapid development of endoscopic technology in recent years,the comparison of endoscopic surgical step-up therapy in INP patients has become a hot topic of debate.This article aims to review the development of INP surgical step-up strategies and the utilized intervention methods;besides,in view of the characteristics of surgery and endoscopic treatment,summarize the development status of INP treatment,and look forward to the development prospect.更多还原