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Z Gastroenterol 2008; 46(8): 790-798
DOI: 10.1055/s-2008-1027467
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Akute Pankreatitis: Wann ist der Chirurg gefragt?

Acute Pancreatitis: Is there a Need for Surgery?A. Kleespies1 , W. E. Thasler1 , C. Schäfer2 , G. Meimarakis1 , M. E. Eichhorn1 , C. J. Bruns1 , K.-W Jauch1 , N. Zügel3
  • 1Klinik und Poliklinik für Chirurgie, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • 2Medizinische Klinik II, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • 3Centre Chirurgical, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxemburg
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Publikationsverlauf

Manuskript eingetroffen: 31.12.2007

Manuskript akzeptiert: 16.4.2008

Publikationsdatum:
29. August 2008 (online)

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Zusammenfassung

Die Behandlung der akuten Pankreatitis erfolgt heutzutage primär konservativ. Insbesondere die zunehmend interdisziplinäre Behandlung und optimierte Intensivtherapie hat in den letzten Jahren zu einer deutlichen Verbesserung der Prognose der schweren nekrotisierenden Pankreatitis geführt. Die frühzeitige Operation wurde aufgrund hoher Morbidität und Mortalität verlassen und durch ein primär konservatives intensivtherapeutisches Management ersetzt. Im Verlauf der Erkrankung gibt es jedoch weiterhin bestimmte Indikationen zur chirurgischen Therapie. Die Cholezystektomie bei biliärer Pankreatitis, die Nekrosektomie bei infizierter Nekrose und progressiver Sepsis und die Notfalloperation bei Hohlorganperforation oder Blutung gehören dazu. Der folgende Artikel gibt einen Überblick über chirurgische Indikationen, optimale Terminierung der Operation und konkurrierende chirurgische und nichtchirurgische Behandlungskonzepte wie laparoskopische oder endoskopische Verfahren. Alle hier genannten Verfahren erfordern ein erfahrenes Team aus Gastroenterologen, Viszeralchirurgen, Radiologen und Intensivmedizinern, das den potentiell vital bedrohlichen Komplikationen jederzeit gewachsen ist. Für die Therapie einer schweren nekrotisierenden Pankreatitis sollte der Patient in ein entsprechendes Zentrum verlegt werden.

Abstract

The treatment of acute pancreatitis is primarily non-surgical. An interdisciplinary approach as well as timely and aggressive intensive care has led to a significant improvement of the prognosis in severe necrotising pancreatitis. Early surgical procedures were associated with high morbidity and mortality and therefore were abandoned and replaced with forceful conservative treatment. However, there are still specific indications for surgery during the course of acute pancreatitis. These include cholecystectomy for biliary pancreatitis, surgical debridement of infected necrosis in septic patients and emergency operations for gastrointestinal perforations or haemorrhage. The following article focuses on surgical indications, optimal timing of surgery and competing surgical and non-surgical concepts like laparoscopic or endoscopic management. All mentioned procedures demand the cooperation of an experienced team of gastroenterologists, surgeons, radiologists and intensive care specialists, who are able to manage the potentially life-threatening complications of this disease. All patients with severe necrotising pancreatitis should be transferred to a specialised centre for interdisciplinary therapy.

Schlüsselwörter

Pankreatitis - nekrotisierenden Pankreatitis - chirurgische Therapie - Nekrosektomie - Endoskopie - FNP

Key words

pancreatitis - pancreatic necrosis - surgical treatment - necrosectomy - endoscopy - FNP

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Dr. Axel Kleespies

Klinik und Poliklinik für Chirurgie, Klinikum Großhadern, Ludwig-Maximilians-Universität München

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