<meta charset="utf8"></head><body>腹腔镜腹膜后坏死性胰腺炎并发症的治疗

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	<li>Wang, S. Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+day+when+infection+is+confirmed+is+a+better+time+point+for+mortality+prediction+in+patients+with+severe+acute+pancreatitis.">The day when infection is confirmed is a better time point for mortality prediction in patients with severe acute pancreatitis.</a> Pancreas. 41 (4), 605-610 (2012).</li><li>Zou, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Study+on+the+related+factors+of+severe+pancreatitis+complicated+with+early+infection.">A Study on the related factors of severe pancreatitis complicated with early infection.</a> Modern Chinese Doctor. 45 (20), 13-14 (2007).</li><li>Shen, Y. F., Cui, N. 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IAP/APA evidence - based guidelines for the management of acute pancreatitis.</a> Pancrcatology. 13 (4), 15 (2013).</li><li>Chen, P., Tang, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+severe+acute+pancreatitis+with+laparoscopic+drainage+via+posterior+approach.">Treatment of severe acute pancreatitis with laparoscopic drainage via posterior approach.</a> Chinese J Curr Adv Gen Surg. 12 (11), 928-930 (2009).</li><li>Sileikis, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-port+retroperitoneoscopic+necrosectomy+in+management+of+acute+necrotic+pancreatitis.">Three-port retroperitoneoscopic necrosectomy in management of acute necrotic pancreatitis.</a> Medicina. 46 (3), 176-179 (2010).</li><li>Zhang, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Technique+of+anatomical+retroperitoneoscopic+adrenalectomy+with+report+of+800+cases.">Technique of anatomical retroperitoneoscopic adrenalectomy with report of 800 cases.</a> J Urol. 177 (4), 1254-1257 (2007).</li><li>Chinese Society of Surgical Infection and Intensive Care, Chinese Society of Surgery, Chinese Medical Association, Chinese College of Gastrointestinal Fistula Surgeons, Chinese College of Surgeons, Chinese Medical Doctor Association. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chinese+guidelines+for+the+diagnosis+and+management+of+intra-+abdominal+infection.">Chinese guidelines for the diagnosis and management of intra- abdominal infection.</a> Chinese J Pract Surg. 40 (1), 1-16 (2020).</li><li>Banks, P. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Classification+of+acute+pancreatitis-2012:+revision+of+the+Atlanta+classification+and+definitions+by+international+consensus.">Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus.</a> Gut. 62, 102-111 (2013).</li><li>Hong, C., Sun, B., Lu, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preliminary+exploration+of+basic+treatment+principles+for+severe+acute+pancreatitis.">Preliminary exploration of basic treatment principles for severe acute pancreatitis.</a> Chinese J Surg. 45 (1), 6-8 (2007).</li><li>Adler, D. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Conservative+management+of+infected+necrosis+complicating+severe+acute+pancreatitis.">Conservative management of infected necrosis complicating severe acute pancreatitis.</a> Am J Gastroenterol. 98 (1), 98-103 (2003).</li><li>Yao, J. R., Tian, Y. Z., Liu, S. Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incremental+trauma+surgical+mode+for+the+treatment+of+severe+acute+pancreatitis.">Incremental trauma surgical mode for the treatment of severe acute pancreatitis.</a> Chinese J Joint Surg. 9 (3), 213-215 (2020).</li><li>Penghao, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+versus+minimally+invasive+surgical+approach+for+infected+necrotizing+pancreatitis:+a+systematic+review+and+meta-analysis+of+randomized+controlled+trials.">Endoscopic versus minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis of randomized controlled trials.</a> Ann Med. 55 (2), 1-13 (2023).</li><li>Pancreatic Surgery Group, Surgery Branch, Chinese Medical Association. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+for+the+diagnosis+and+treatment+of+acute+pancreatitis.">Guidelines for the diagnosis and treatment of acute pancreatitis.</a> Chinese J Digest Surg. 20 (7), 730-739 (2021).</li><li>Van Santvoort, H. 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<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Dissecting forceps</td>
			<td>KANGJI</td>
			<td>ZP485RB 330mm&#215;&#934;5</td>
			<td></td>
		</tr>
		<tr>
			<td>Drainage tube</td>
			<td>Kang-Li</td>
			<td>QH-F28</td>
			<td></td>
		</tr>
		<tr>
			<td>Grasping forceps</td>
			<td>KANGJI</td>
			<td>ZP531RB 330mm&#215;&#934;5</td>
			<td></td>
		</tr>
		<tr>
			<td>Laparoscope</td>
			<td>STORZ</td>
			<td>26003BA</td>
			<td></td>
		</tr>
		<tr>
			<td>Normal Saline 3000ml</td>
			<td>Ke-Lun</td>
			<td>3000ml:27g</td>
			<td></td>
		</tr>
		<tr>
			<td>Suction and Irrigation</td>
			<td>KANGJI</td>
			<td>&#934;5/&#934;10&#215;330mm</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture</td>
			<td>ETHICON</td>
			<td>SA86G</td>
			<td></td>
		</tr>
		<tr>
			<td>Trocar</td>
			<td>KANGJI</td>
			<td>ZP015RN &#934;5.5/ ZP018RN &#934;12.5</td>
			<td></td>
		</tr>
		<tr>
			<td>Ultrasonic knife</td>
			<td>An-He</td>
			<td>AH-600</td>
			<td></td>
		</tr>
		<tr>
			<td>Veress needle</td>
			<td>KANGJI</td>
			<td>ZP001RN &#934;2.5&#215;100mm</td>
			<td></td>
		</tr>
	</tbody>
</table>

retroperitoneal laparoscopic debridement and drainage for pancreatic abscess

The treatment of severe acute pancreatitis (SAP) complicated by peripancreatic infection and necrosis has long been a difficult problem to solve1,2. Pancreatic infection and necrosis are serious complications of severe acute pancreatitis3. Reducing abdominal and retroperitoneal pressure, removing necrotic tissue as much as possible, and reducing the absorption of toxic substances are the main surgical principles for successfully treating SAP4. Traditional open surgery and continuous postoperative lavage have saved the lives of many SAP patients. However, the transabdominal approach requires perforation of the gastrocolic ligament, entry into the minor omental sac, and subsequent invasion of all segments of the pancreas, which inevitably interferes with various abdominal organs and might introduce retroperitoneal bacteria into the abdominal cavity, increasing the risk of abdominal infection. In addition, the drainage tube is drained from the retroperitoneal cavity to the outside of the abdominal wall. Owing to poor drainage, compression of the intestinal tube may also cause intestinal fistula and abdominal bleeding. In 2013, the Evidence-based Guidelines for the Treatment of Acute Pancreatitis issued by the International Society of Pancreatology and the American Society of Pancreatology noted that minimally invasive debridement of necrotic tissue was superior to open debridement for patients with symptomatic infectious necrosis5. Chen et al.6 used peritoneal laparoscopy to reach the peritoneum, remove necrotic pancreatic tissue, and place the drainage tube, achieving satisfactory results. However, theoretically, problems such as bacterial displacement and peritoneal infection caused by communication between the peritoneum and retroperitoneum are inevitable. Sileikis et al.7 used three-hole laparoscopic retroperitoneal resection of pancreatic necrotic tissue and catheter drainage from 2007 to 2009 and cured 8 SAP patients.
Since 2016, we have adopted retroperitoneal laparoscopy to remove necrotic pancreatic tissue through a retroperitoneal approach. Compared to other minimally invasive surgeries, this method is more direct and safer. It provides direct access to the retroperitoneal space, allowing direct visualization and removal of necrotic tissue in the renal capsule. The field of view is clear, bleeding is easily controlled, and a drainage tube can be placed as needed, ensuring effective drainage. The drainage tube does not pass through the abdominal cavity, causing minimal disturbance to the cavity and reducing the risk of abdominal infection. The necrosis and infection of SAP occur mostly in the tail of the pancreas. There is often necrosis of the peripancreatic fatty tissue, which sometimes extends into the left colonic sulcus. Therefore, we utilized a left-sided approach in all patients, and typically, a single surgery was sufficient to thoroughly remove the necrotic tissue. We believe that retroperitoneal laparoscopic surgery via a left-sided approach is particularly suitable for patients with necrosis of the pancreatic body and tail combined with massive effusion.

<meta charset="utf8"></head><body>作者聚焦：坏死性胰腺炎腹膜后入路的进展

腹膜后腹腔镜清创引流治疗胰腺脓肿

Read this Scientific Article Protocol about Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis at JoVE.com

In patients with severe necrotizing pancreatitis, pancreatic necrosis and secondary infection of surrounding tissues can quickly spread to the whole ...

retroperitoneal-laparoscopic-debridement-drainage-for-pancreatic

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Medicine

Retroperitoneal Laparoscopic Debridement and Drainage for Pancreatic Abscess

273 次观看.  Meizhou People’s Hospital. 我们的研究范围是坏死性胰腺炎的手术治疗。我们试图回答的问题包括如何引流患者胰腺周围的脓肿，以控制感染。我们目前研究的主要挑战在于成功建立腹膜后通道，以及可能由去除坏死组织引起的术间出血。与开放和传统的腹腔镜手术相比，我们的技术简化了腹膜后器官的暴露，降低了腹部器官受伤的风险，并促进了术后引流。

视频: 作者聚焦：坏死性胰腺炎腹膜后入路的进展

In patients with severe necrotizing pancreatitis, pancreatic necrosis and secondary infection of surrounding tissues can quickly spread to the whole retroperitoneal space. Treatment of pancreatic abscess complicating necrotizing pancreatitis is difficult and has a high mortality rate. The well-accepted treatment strategy is early debridement of necrotic tissues, drainage, and postoperative continuous retroperitoneal lavage. However, traditional open surgery has several disadvantages, such as severe trauma, interference with abdominal organs, a high rate of postoperative infection and adhesion, and hardness with repeated debridement. The retroperitoneal laparoscopic approach has the advantages of minimal invasion, a better drainage route, convenient repeated debridement, and avoidance of the spread of retroperitoneal infection to the abdominal cavity. In addition, retroperitoneal drainage leads to fewer drainage tube problems, including miscounting, displacement, or siphon. The debridement and drainage of pancreatic abscess tissue via the retroperitoneal laparoscopic approach plays an increasingly irreplaceable role in improving patient prognosis and saving healthcare resources and costs. The main procedures described here include laying the patient on the right side, raising the lumbar bridge and then arranging the trocar; establishing the pneumoperitoneum and cleaning the pararenal fat tissues; opening the lateral pyramidal fascia and the perirenal fascia outside the peritoneal reflections; opening the anterior renal fascia and entering the anterior pararenal space from the rear; clearing the necrotic tissue and accumulating fluid; and placing drainage tubes and performing postoperative continuous retroperitoneal lavage.

To improve the drainage of patients with necrotizing pancreatitis complicated with peripancreatic abscess and reduce the mortality of patients with necrotizing pancreatitis, we adopted a retroperitoneal approach for peripancreatic abscess debridement and drainage by laparoscopy.