Interpretation of guidelines for the diagnosis and treatment of acute pancreatitis (2014)- Present status and development actuality of treatment of acute pancreatitis

WANG Chun-you; YANG Ming

doi:10.7504/CJPS.ISSN1005-2208.2015.01.03

Abstract：The "Guidelines for the Diagnosis and Treatment of severe acute pancreatitis"were published by the Pancreatic Surgery Group of Surgery Branch of Chinese Medical Association in 2007, and had had great impact on the standardized treatment and the improvement of outcome of AP. Recently, tremendous progress has been achieved in the research of acute pancreatitis (AP), which influenced many important aspects of the management of acute pancreatitis. Therefore it is necessary to revise the guideline. And the revised guideline is renamed as"Guidelines for the Diagnosis and Treatment of Acute Pancreatitis (2014)". Referring to the latest international progress, the severity of AP is classified as mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). The definition of SAP or MSAP depends on the duration of organ failure, which is translent(≤48h) in MSAP but is persistent(>48h) in SAP. Based on clinic practices of Chinese group, the dynamic disease process could be divided into three phases. Early stage (acute phase) usually lasts for one to two weeks, and is characterized by systemic inflammatory response syndromes (SIRS) and organ failure, which is the first peak of mortality. Middle stage (evolution phase), after acute phase, has a peripancreatic fluid collection or necrotic collection as the major characteristics. Late stage (infection phase), after the fourth week, could cause the infection of pancreas and peripancreatic necrotic tissues, and is the second peak of mortality. Acute peripancreatic fluid collection (APFC), acute necrotic collection (ANC), walled-off necrosis (WON) together with pancreatic pseudocyst are the local complications. The indications for surgical treatment are infected necrosis and oppression symptom. Surgery should not be operated in sterile necrosis without symptoms. Surgical treatment should be delayed. In patients with infected necrosis, antibiotic and PCD could be the first choice of treatment. Surgical interventions of infected pancreatic necrosis include PCD, endoscopic, minimally invasive surgery (such as small incision surgery, video-assisted surgery) and open surgery (necrosectomy and drainage by the abdominal or retroperitoneal approach). The infected pancreatic necrosis is complex and diverse, rational surgical procedures should be selected separately or jointly considering the condition in individual cases.