摘要
创伤递升式分阶段治疗(step-up approach)是目前治疗感染性胰腺坏死(IPN)的重要模式之一,已获得多个指南的肯定与推荐。然而,IPN病情的复杂性与多变性决定了其治疗不能采用同一种策略。对于部分须进行外科干预的病人,应跨越传统的递升式策略,采取"step-jump"或"一步法"等跨阶梯治疗策略提前干预。同时,创伤递升式分阶段治疗IPN应根据感染病变的位置与分型、医院的学科特色、医生的技术特点具体实施,以制定精准化的微创递升式治疗策略。"step-up approach"策略中的开放性清创是在合理指征与时机下开展的,安全有效,仍不可摒弃。现阶段,遵循"step-up"策略治疗IPN时,更提倡内镜式与外科式干预并行、递升式与跨越式策略并进,建立以疾病为中心的多学科一体化治疗平台,以改善临床预后。
"Step-up approach"is one of the important treatment approaches of contemporary infected pancreatic necrosis(IPN),which has been accepted and advocated by the most of guidelines.Due to the complexity and frequent changes of IPN,the same method should not be used in the treatment of all IPN.For some patients who are bound to need surgical intervention,surgeons should leapfrog the traditional"step-up approach"treatment procedure,and adopt the"stepjump"or"ones step"strategy to intervene patients in advance.Meanwhile,step-up treatment of IPN should be implemented according to the location and classification of the infected site,the subject advantage of the hospital and the technical characteristics of doctors,so as to develop precise minimally invasive treatment strategies.Furthermore,the open debridement in the step-up approach is performed at the appropriate timing under the right indication,so it is safe,available and irreplaceable.At the present stage,it is more advocated to treat IPN with endoscopic and surgical intervention in parallel following step-up approach,as well as with step-up or step-jump strategies.Clinicians should establish a comprehensive treatment platform centered on diseases to optimize the clinical efficacy of acute necrotizing pancreatitis patients.
作者
孙备
李冠群
SUN Bei;LI Guan-qun(Department of Pancreatic and Biliary Surgery,the First Affiliated Hospital of Harbin Medical University&Key Laboratory of Hepatosplenic Surgery,Ministry of Education,Harbin 150001,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2021年第4期374-378,共5页
Chinese Journal of Practical Surgery
基金
国家自然科学基金(No.81871974,No.82070658)。
作者简介
通信作者:孙备,E-mail:sunbei70@tom.com。
