[Re-exploration of minimally invasive surgery for infected pancreatic necrosis]

Zhonghua Wai Ke Za Zhi. 2019 Oct 1;57(10):11-13. doi: 10.3760/cma.j.issn.0529-5815.2019.10.003.
[Article in Chinese]

Abstract

The application of minimally invasive technique in infected pancreatic necrosis has been matured gradually but has controversy and challenges in the same time. This paper further discusses the advantages, timing, combination of multi-video-assisted debridement and post-operative management of minimally invasive surgery. The greatest advantage of minimally invasive surgery lies in "No intervention for normal abdominal space" which not only can reduce unnecessary injury and complication but also promote intestinal function recovery after operation. The principle of delayed operation is controversial. Early PCD and " one-step" minimally invasive laparoscopic debridement and drainage have both achieved good results. The combination of multi-video-assisted minimally invasive technique can make up for the shortage of single technique to shorten the operation time and improve the debridement efficiency of patients with complicated infected pancreatic necrosis and provide new ideas for video-assisted debridement. Fully debridement and drainage are the key points and standardization for post-operative management. It's a difficult problem and an important research direction to apply minimally invasive technique for patients with infected pancreatic necrosis reasonably and scientifically.

微创技术在治疗感染性胰腺坏死中的应用逐渐成熟,同时也面临争议与挑战。本文对微创处理优势、时机、联合多视频清创及术后管理等方面进行再探讨。微创处理的优势在于"不干扰腹腔正常间隙" ,减少不必要的干预及损伤,降低并发症发生率,促进术后肠功能恢复。延期手术原则存在争议,早期穿刺置管引流或微创"一步法"腹腔镜清创引流术亦可取得较好效果。联合多视频辅助微创技术可弥补单一技术的不足,缩短手术时间,提高复杂感染性胰腺坏死患者的清创效率,为视频辅助清创提供新思路。我们认为"充分清创引流"是关键,"规范术后管理"是保障。合理并科学的将微创技术应用于感染性胰腺坏死患者治疗以达到最优效果将是未来外科医师需不断探索的难题和方向。.

Keywords: Infected pancreatic necrosis; Pancreatitis; Surgical procedures, minimally invasive.

MeSH terms

  • Debridement
  • Drainage
  • Humans
  • Laparoscopy
  • Minimally Invasive Surgical Procedures / methods
  • Minimally Invasive Surgical Procedures / standards*
  • Pancreatitis, Acute Necrotizing / surgery*
  • Postoperative Care
  • Reoperation
  • Time-to-Treatment
  • Video-Assisted Surgery