Necrotizing Pancreatitis : Significance, Detection, and Treatment
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概要
- 論文の詳細を見る
Clinicopathologic correlation of the clinical course of acute pancreatitis with tissue changes occurring within the pancreas has revealed that pancreatic necrosis is the principal determinant of clinical severity and overall survival from acute pancreatitis. Furthermore, we now know that secondary pancreatic infections(infected pseudocyst, pancreatic abcess, infected pancreatic necrosis)are decidedly rare in the absence of pancreatic necrosis. Since secondary pancreatic infections associated with pancreatic necrosis currently account for more than 80% of deaths from acute pancreatitis, the diagnosis and management of necrotizing pancreatitis has assumed increasing importance. Serum tests capable of detecting significant amounts of pancreatic necrosis have not as yet proved reliable. Currently, dynamic contrast-enhanced CT scanning remains the gold standard for detecting pancreatic necrosis, with an overall accuracy rate exceeding 90%. Extensive sterile pancreatic necrosis can often be successfully managed by non-operative means, even when associated with organ faliure. Infected pancreatic necrosis, on the other hand, is uniformly lethal without operative debridement and drainage. Clinical differentiation between sterile pancreatic necrosis and infected pancreatic necrosis is often difficult, however. This distinction has been materially assisted by transcutaneous fine needle aspiration bacteriology. Infected pancreatic necrosis differs from all other types of surgical infections, in that recurrence of infection following initial debridement and drainage is the rule, rather than the exception. This pernicious feature may be a consequence of the loss of pancreatic ductal integrity due to parenchymal necrosis, with continued leakage of activated enzymes into the retroperitoneum. Surgical mortality rates for infected pancreatic necrosis of 15% or less have been reported from many centers using open packing and planned re-exploration. Although truly remarkable progress has been made in managing patients with severe acute pancreatitis in the past 15years, much is left to be done. Acute pancreatitis is a disease of protean clinical manifestations, ranging from mild abdominal pain and minor social inconvenience, to apocalyptic prostration and death. The pancreatic inflammatory process may remain localized in the superior retroperitoneum, undergo regional extension, or even result in systemic illness associated with remote organ dysfunction. As a general rule for every four patients with acute pancreatitis, three will recover uneventfully using supportive measures alone ; the fourth, however, will suffer a complication, and stand a one-in-three chance of dying. With such diversity of presentation, variation in severity, and uncertainty of outcome, individualization is the key to successful management of patients with acute pancreatitis.
- 一般社団法人日本消化器外科学会の論文
- 1992-09-01
著者
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Bradley Iii
Surgery Emory University
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Whitaker Jr.
Surgery,Emory University
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Whitaker Jr.
Surgery Emory University