摘要
重症医学的发展及“微创升阶梯”和“内镜升阶梯”治疗模式的引入显著改善了重症急性胰腺炎(SAP)病人的预后。随着近期疗效的提升,SAP的远期并发症逐渐成为临床医生关注的焦点。胆道狭窄(BS)是SAP罕见的远期严重并发症,可导致危及生命的胆管炎、进行性肝功能损害和继发性胆汁性肝硬化。严重的局部和全身性炎症反应,以及胰头或胰颈部区域坏死积液压迫是BS发生发展的主要原因。此外,房颤、内脏静脉血栓形成和胰头坏死被认为是BS发生的独立危险因素。SAP继发BS的理想治疗策略目前尚不明确,缺乏具有指导意义的指南或共识。然而,良性BS的治疗指南可以作为参考应用于这一临床情况。内镜下胆道支架置入是目前治疗BS的首选方法,经皮介入和外科手术是内镜治疗失败的重要补充。快速清除坏死组织及有效控制炎症,可能减缓BS的进展。
The advancements in intensive care medicine,along with the introduction of minimally invasive step-up and endoscopic step-up approaches,have significantly improved the prognosis of patients with severe acute pancreatitis(SAP).However,with improvement in short-term efficacy,the long-term complications of SAP have gradually become a focus of clinical concern.Biliary stricture(BS)is a rare but severe late-stage complication of SAP,which can result in life-threatening cholangitis,progressive liver impairment,and secondary biliary cirrhosis.Severe local and systemic inflammatory response,as well as compression from necrotic fluids in the pancreatic head/neck region,are considered two main causes of the development of BS.Additionally,atrial fibrillation,splanchnic vein thrombosis,and pancreatic head necrosis are regarded as independent risk factors for BS.The optimal treatment strategy for SAP-associated BS remains unclear due to the absence of instructive guidelines or consensus.Nevertheless,clinical guidelines for the management of benign BS can be referenced for application in this clinical setting.Endoscopic placement of biliary stents is currently the preferred method for treating BS,with percutaneous intervention and surgical procedures serving as important supplements in cases where endoscopic treatment fails.Prompt removal of necrotic tissues and effective control of inflammation can ameliorate the progression of BS.
作者
宁彩虹
黄耿文
NING Cai-hong;HUANG Geng-wen(Division of Pancreatic Surgery,Department of General Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2024年第5期537-540,共4页
Chinese Journal of Practical Surgery
基金
湖南省自然科学基金项目(No.2023JJ30885)。
关键词
重症急性胰腺炎
胆道狭窄
内镜
severe acute pancreatitis
biliary stricture
endoscopy
