Clinical application of minimallly invasive technique in the surgical treatment of severe acute pancreatitis—Consensus and controversy

随着微创理念的发展,重症急性胰腺炎局部并发症的外科治疗方式发生了很大变化.传统开腹清创引流手术由于其并发症发生率和病死率较高,逐渐被经皮穿刺引流、内镜、肾镜、腹腔镜等微创技术取代.对有手术指征的重症急性胰腺炎患者,推荐采用创伤递进式治疗策略,先行经皮穿刺引流或内镜技术缓解急性感染症状,对效果不佳者可再行坏死组织清除术,提倡视频辅助、经皮肾镜、腹腔镜等微创术式,可减少危重患者外科干预后的创伤和相关并发症,对某些患者,微创治疗可能完全替代传统外科手术.The surgical treatment of severe acute pancreatitis has been significantly changed in recent years with the progress of minimally invasive surgery .Traditional open surgical debridement and drainage of peripancreatic necrotic tissue was associated with high morbidity and mortality , therefore conversion to minimally invasive procedures was increasingly acceptedu , including percutaneous catheter drainage, endoscopic, nephroscopic and laparoscopic approaches .For selected severe acute pancreatitis patients, a step-up approach was recommended , with percutaneous or endoscopic drainage would be performed firstly to relieve the severe infection .Once drainage could not lead to clinical relief , minimally invasive necrosectomy and debride should be considered , including video assisted retroperitoneal debridement , nephrosopic or laparoscopic treatment .The step-up minimally invasive approach for treatment of infected severe acute pancreatitis could decrease the rate of complications and could completely replace open surgery , and could achieve a good outcome in selected patients .国家自然科学基金面上项目(81372605、81572339、81672353)4271-2741