This study by van Brunschott and international colleagues1 has shown that when possible in high-risk patients with severe acute necrotising pancreatitis, a minimal access approach for drainage combined with a necrosectomy, either via an operative (ie, laparoscopic like) or an endoscopic transgastric or transduodenal approach, decreases mortality of this horrible disease when compared with the classic open operation (laparotomy). These data are convincing and support the use of such minimal access approaches whenever feasible. This study reviews the data on another huge advance in our treatment and understanding of this horrific disease. In this commentary, I want to use this study as an example of the marked changes in our thinking of pancreatitis over the last 40 years. Our current approach to the treatment of necrotising pancreatitis really had its origin in the 1970s with the introduction of the new concept of an operative ‘necrosectomy’ rather than just peripancreatic drainage which at that time was designed to remove the bad humours believed to be the cause of the systemic aspects of the disease. Through the pioneering work of Beger and colleagues2 in Ulm, Germany and that of Bradley (and Stone) in Atlanta, Georgia, USA,3 a new era emerged with our thinking of this systemic inflammatory disease originating from endogenous pancreatic parenchymal necrosis and later, its superinfection. Indeed, the introduction of the importance of removing the infected necrotic tissues (necrosectomy) combined with drainage of the peripancreatic region immediately decreased the mortality of this disease …

中文翻译：

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最小通路坏死切除术：许多治疗坏死性胰腺炎的最新进展

van Brunschott 和国际同事 1 的这项研究表明，在可能的情况下，对于患有严重急性坏死性胰腺炎的高危患者，通过手术（即腹腔镜手术）或内窥镜经胃或与经典的开放手术（剖腹手术）相比，经十二指肠方法降低了这种可怕疾病的死亡率。这些数据令人信服，并支持在可行的情况下使用此类最少访问方法。这项研究回顾了我们对这种可怕疾病的治疗和理解的另一个巨大进步的数据。在这篇评论中，我想以这项研究为例，说明过去 40 年来我们对胰腺炎的看法发生了显着变化。我们目前治疗坏死性胰腺炎的方法确实起源于 1970 年代，当时引入了手术“坏死切除术”的新概念，而不仅仅是胰周引流术，当时旨在去除被认为是病因的恶液疾病的全身性方面。通过德国乌尔姆的 Beger 及其同事 2 和美国佐治亚州亚特兰大的 Bradley（和斯通）3 的开创性工作，我们对这种起源于内源性胰腺实质坏死的全身性炎症性疾病的思考出现了一个新时代，后来，其双重感染。事实上，引入被感染的坏死组织（坏死切除术）结合胰周区域引流的重要性立即降低了这种疾病的死亡率……