感染性胰腺坏死的治疗进展

急性胰腺炎是一种内科常见急症，胰腺坏死并发感染可导致严重脓毒血症甚至多器官功能衰竭。近年来，随着消化内外科微创手术水平的快速提高，微创升阶梯理念已逐渐代替外科清创，成为胰腺感染性坏死（infected pancreatic necrosis, IPN）的首选治疗策略。本文对超声内镜下穿刺引流-内镜下经腔坏死切除术-LAMS支架置入+鼻胆管引流的消化内镜下升阶梯治疗策略的有效性、安全性以及内镜下操作细节等作一详细综述，对内镜升阶梯治疗与外科微创升阶梯治疗策略的各自优势进行阐述，为IPN临床治疗策略的选择提供理论指导。

Treatment progress of infected pancreatic necrosis

Acute pancreatitis is a common gastrointestinal disorder. Infected pancreatic necrosis (IPN) can result in severe sepsis and eventually multiple organ failure (MODS). In recent years, the minimally invasive step-up approach has gradually replaced surgical debridement and become the preferred treatment choice for IPN. This review summarized the effectiveness, safety and procedure details of the minimally invasive step-up approach for IPN, including ultrasound-guided endoscopic transluminal drainage, endoscopic transluminal necrossectomy, lumen-apposing metal stents implantation and nasobiliary drainage based on the relevant literature; and also elaborates the advantages of minimally invasive and endoscopic step-up approach to provide information for clinical treatment of IPN.