Therapie der akuten Pankreatitis

Kernaussagen

Bei der unkomplizierten ödematös-interstitiellen Pankreatitis liegt die Mortalität unter 1 %, bei der hämorrhagisch-nekrotisierende Pankreatitis dagegen bei 10 – 24 %. Frühe prognostische Faktoren zur Beurteilung des klinischen Verlaufs sind 3 oder mehr Hinweise auf Organkomplikationen oder der Nachweis von Pankreasnekrosen im kontrastmittelverstärkten CT. Auch ein bis auf 130 mg/l erhöhter CRP-Wert kann frühzeitig auf einen komplizierten Verlauf hinweisen.

Die entscheidende therapeutische Maßnahme bei der Behandlung der akuten Pankreatitis ist die ausreichende Substitution des Flüssigkeitsverlusts. Außerdem muss eine suffiziente analgetische Therapie oberstes Ziel der Behandlung sein. Eine antibiotische Therapie sollte Patienten mit infizierter Nekrose vorbehalten bleiben und nicht als grundsätzliche Prophylaxe eingesetzt werden. Eine enterale Ernährung bei Patienten mit akuter Pankreatitis ist der parenteralen Ernährung überlegen, kann sie aber nicht immer vollständig ersetzen.

Die minimal invasiven Therapieverfahren sind der offenen Operation bei infizierter Nekrose überlegen. Bei biliärer Pankreatitis ist eine endoskopische Papillotomie während des ersten stationären Aufenthalts notwendig. Innerhalb von 6 Wochen nach der Klinikentlassung sollte man dann eine Cholezystektomie durchführen.

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