胰腺炎临床过程和处理.docVIP

ISSN 1007-9327 CN 14-1219/R? World J Gastroenterol? 2007 October 14; 13(38): 5043-5051 Severe acute pancreatitis: Clinical course and management S Bhattacharya, D Banerjee, AK Bauri, S Chattopadhyay, SK Bandyopadhyay ? ? ? ? Hans G Beger, Department of General Surgery, Department of Viszeralsurgery, University of Ulm (1982-2001), Donau-Klinikum, Neu-Ulm, Germany Bettina M Rau, Department of General, Viszeral, Vascular and Pediatric Surgery, Universit?tsklinikum des Saarlandes, Homburg/ Saar, Germany Correspondence to: Hans G Beger, MD, c/o University Hospital, Steinhoevelstr. 9, D-89075 Ulm, Germany. hans.beger@medizin.uni-ulm.de Telephone: +49-731 Fax: +49-731Received: March 13, 2007?????????Revised: August 11, 2007 ?? Abstract Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis ( 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis-Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early