摘要随着对重症急性胰腺炎(SAP)病理生理学研究的不断深入及大量循证医学证据的不断涌现,强调微创化、损伤控制的创伤递升式分阶段治疗SAP理念已获得大多数指南性文件的肯定与推崇.对于确诊或疑似感染性胰腺坏死患者,先行影像学引导下的经皮穿刺置管引流或内镜下内引流;若有必要,则进一步行内镜下腹膜后入路小切口坏死组织清除术、视频辅助下腹膜后入路坏死组织清除术或内镜下经胃或十二指肠的坏死组织清除术,甚至开放性坏死组织清除术.创伤递升式分阶段治疗SAP在显示其优越的临床意义及卫生经济学价值的同时,仍有一些问题需进一步的探讨与优化.

abstractsBoth new insights in the pathophysiology of severe acute pancreatitis (SAP) and upspringing related evidence-based supports prompt the staged step-up approach,which stress emphasis on minimal invasiveness and damage control,to be accepted and advocated by the majority of guidelines.For documented or suspected patients with infected pancreatic necrosis,an imaging-guided percutaneous catheter drainage or an endoscopic transluminal drainage should be initially performed followed by,if necessary,a minimal access retroperitoneal necrosectomy,or a video-assisted retroperitoneal debridement,or an endoscopic transluminal necrosectomy,or an even an open access necrosectomy.The outstanding performance of staged step-up approach in patients with SAP has been justified from both a clinical and a health economic point of view,meanwhile,there are some issues remained to be further elucidated and optimized.