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重症急性胰腺炎(SAP)的治疗经历了一个多世纪的艰苦探索,从最初积极手术到提倡保守治疗,再到选择性手术干预;从简单手术引流、早期胰腺包膜切开引流到胰腺切除,再到坏死组织清除。如今SAP的整体病死率已从当初的60%~80%下降至10%~20%。SAP的治疗涉及到早期液体复苏、器官功能的保护与替代治疗、腹腔间隔室综合征的处理,以及营养代谢调理、感染并发症的防治及坏死后病变的手术等。进一步加强对SAP多器官功能障碍及胰腺坏死后病变及感染并发症的综合防治,准确把握手术时机及选择正确的手术方式,有望实现SAP疗效的突破。

Emphasis on multidisciplinary treatment of severe acute pancreatitis

The treatment of severe acute pancreatitis(SAP) has experienced more than a century of exploration.Initially surgery followed by conservative treatment was advocated,and then selective surgical intervention was adopted.Procedures also changed through time,from a simple surgical drainage to pancreatic capsule incision and drainage to pancreatectomy and then necrosectomy.Today,the overall mortality rate of SAP has decreased from 60%~80% to 10%~20%.Therefore,the treatment of SAP include early fluid resuscitation,organ protection and replacement therapy,the treatment of abdominal compartment syndrome,as well as nutritional support,prevention of complications and surgical intervention.Comprehensive prevention and treatment of MODS,infectious complications,as well as accurate timing and approach of surgical intervention should be strengthened to achieve a breakthrough to the effectiveness of SAP management.