脓腔灌洗在感染性胰腺坏死治疗中的应用进展

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灌洗长期应用于感染性胰腺坏死的治疗,根据灌洗部位不同可将其分为腹腔灌洗和脓腔灌洗。腹腔灌洗目前应用较少,脓腔灌洗则被广泛应用于开腹、腹腔镜及内镜下胰腺坏死组织清创引流术后治疗,但灌洗液种类、方式、持续时间及停止灌洗指征等到目前均无统一标准,其应用存在争议:支持者认为,脓腔灌洗可稀释并清除术后残留或新产生的坏死组织,清除炎性介质,减少清创次数等,反对者认为灌洗并未明显降低磷脂酶A2等生物活性物质浓度,并且易于形成脓肿及胰周败血症,可造成感染扩散入腹腔形成腹膜炎等。总之,脓腔灌洗可使部分患者尤其是引流管径较细的内镜下清创和经皮穿刺置管引流置管患者获益,但其用于管径较粗而引流相对充分的开腹或视频辅助清创患者是否必要仍需相关随机对照试验进一步研究探讨。“,”Lavage has been used in the treatment of infected pancreatic necrosis(IPN) for a long time.It can be divided into peritoneal lavage and necrotic cavity lavage according to different parts of lavage.At present,peritoneal lavage is rarely used,while necrotic cavity lavage is widely used in laparotomy,minimally invasive surgery and endoscopic debridement and drainage for IPN patients.However,there is no unified standard for the type,method,duration and indication of stopping lavage.The application of lavage is controversial: proponents think that necrotic cavity lavage can dilute and remove residual or new necrotic tissue,remove inflammatory mediators and reduce the times of debridement,etc.While opponents think that lavage can not significantly reduce the concentration of phospholipase A2 and other bioactive substances,and is easy to form abscess and peripancreatic sepsis and cause infection to spread into the abdominal cavity and form peritonitis.In conclusion,necrotic cavity lavage can benefit some patients,especially those with smaller drainage diameter who underwent endoscopic debridement and percutaneous catheter drainage.However,whether it is necessary for patients with larger drainage diameter who underwent laparotomy or video-assisted debridement still needs to be further studied by randomized controlled trials.
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