摘要
急性胆源性胰腺炎(ABP)是急性胰腺炎的最主要类型,占急性胰腺炎50%以上。ABP以胆道疾病为诱发因素,其中胆道微结石是最常见的原因。鉴于消化内镜治疗在胆胰疾病中的广泛应用,其在ABP的诊疗全过程中所起的作用越来越重要。从内镜下辅助ABP治疗决策、ABP病因治疗、处理ABP并发症、预防ABP复发以及进行ABP肠道营养5方面对内镜治疗ABP进行剖析:超声内镜(EUS)可从病因诊断和预后判断辅助ABP治疗决策;内镜逆行胰胆管造影(ERCP)是目前伴随胆管炎或者胆管梗阻的ABP首选治疗方式;EUS或ERCP下建立通道引流减压及后期内镜下清创可缓解胰周液体积聚和胰腺坏死所带来的严重并发症;腹腔镜下胆囊切除术可显著降低ABP的复发率;内镜下放置肠内营养管可保证ABP肠道屏障功能障碍的营养供给。随着内镜微创理念的普及、内镜微创技术的成熟、内镜器械的研发,有望建立内镜贯穿ABP诊治全过程的微创"升阶梯"治疗模式。
Acute biliary pancreatitis(ABP)is considered as one of the most common types of acute pancreatitis,accounting for more than 50%of cases.Biliary diseases are the inducible factors of ABP,among which biliary microlithiasis acts as the most common cause.In terms of the wide application of digestive endoscopy in biliary and pancreatic diseases,it has been increasingly important in the diagnosis and treatment of ABP.In the review,endoscopy assisting in ABP therapeutic decision-making,playing roles in treatment of the causes and complications of ABP,preventing ABP recurrence and achieving intestinal nutrition are clearly summarized.In detail,endoscopic ultrasonography(EUS)can assist the decision making of ABP treatment based on diagnosis of etiology and prediction of prognosis.Endoscopic retrograde cholangiopancreatography(ERCP)has been the preferred treatment for ABP with cholangitis or bile duct obstruction.The establishment of drainage and decompression under EUS or ERCP and the subsequent endoscopic debridement alleviates the serious complications caused by peripancreatic fluid accumulation and pancreatic necrosis.Laparoscopic cholecystectomy significantly reduces the recurrence rate of ABP.Placement of enteral nutrition tube by endoscopic direct vision ensures the nutrition supply of ABP.With the popularization of the concept of minimally invasive endoscopy,the maturity of endoscopic technology and the development of endoscopic instruments,endoscopy has been playing a great role in the whole process of ABP to build a novel minimally invasive"step-up"therapeutic strategy.
作者
李兆申
LI Zhaoshen(Department of Gastroenterology,Changhai Hospital,Naval Medical University,Shanghai 200433,China)
出处
《中国实用外科杂志》
CSCD
北大核心
2020年第11期1234-1239,共6页
Chinese Journal of Practical Surgery
关键词
急性胆源性胰腺炎
内镜逆行胰胆管造影
超声内镜
腹腔镜
acute biliary pancreatitis
endoscopic retrograde cholangiopancreatography
endoscopic ultrasonography
laparoscopy
作者简介
李兆申,E-mail:chzhaoshenli@sina.com
