摘要
急性胆石性胰腺炎(AGP)的病因学防治需从发病的分子机制出发,结合病理解剖基础和病理生理过程对AGP进行系统认识。主胰管梗阻和胆汁酸反流是AGP的发病根源,梗阻持续时间对其进展尤为关键,对胰管梗阻的早期干预是阻断重症化的节点。超声内镜+内镜逆行胰胆管造影+内镜乳头括约肌切开是AGP早期管理策略,尽快明确病因、解除胆胰管梗阻、释放胰管内压力、实施胆总管引流及评估胰管支架作用是诊治核心。胆结石作为唯一的可控因素,尽早行腹腔镜胆囊切除术是防范AGP的安全选择。目前,关于AGP病因学防治的时机与方式仍需深入研究。本文从解剖因素处理、胆石因素防治、发病过程阻断和预防机制配合等方面进行综述,为AGP的防治提供参考。
Acute gallstone pancreatitis(AGP)represents an acute inflammatory condition of the pancreas,of which etiology and prevention require systematic understanding from the molecular mechanisms of onset,combined with the foundations of pathological anatomy and pathophysiological processes.Main pancreatic duct obstruction and bile acid reflux are the primary causes of AGP.The duration of the obstruction is particularly crucial to its progression,and early intervention in pancreatic duct obstruction is key to preventing severe cases.The management strategy for AGP in its early stages includes endoscopic ultrasound,endoscopic retrograde cholangiopancreatography,and endoscopic sphincterotomy.The core of diagnosis and treatment involves promptly identifying the cause,relieving bile and pancreatic duct obstruction,reducing pressure in the pancreatic duct,implementing common bile duct drainage,and evaluating the effect of pancreatic duct stenting.Since gallstones are the only controllable factor,early cholecystectomy is the safest choice for preventing AGP.However,the timing and methods of etiological prevention and treatment of AGP still require further research.This article synthesizes insights into anatomical factor management,gallstone prevention,interruption of the onset process,and coordination of prevention mechanisms,aiming to provide a reference for AGP prevention and treatment.
作者
王奥
张雅男
张莉
郭贤德
李宁
Wang Ao;Zhang Yanan;Zhang Li;Guo Xiande;Li Ning(Nankai Clinical School of Medicine,Tianjin Medical University,Tianjin 300100,China;Department of Hepatopancreatobiliary Surgery,Tianjin Nankai Hospital,Tianjin Medical University,Tianjin 300100,China;Department of Endoscopy Centre,Tianjin Nankai Hospital,Tianjin Medical University,Tianjin 300100,China)
出处
《中华肝胆外科杂志》
北大核心
2025年第2期150-155,共6页
Chinese Journal of Hepatobiliary Surgery
基金
天津市自然科学基金重点项目(21JCZDJC00550)。
关键词
胰腺炎
胆结石
病因学
防治
Pancreatitis
Gallstone
Etiology
Prophylaxis and treatment
