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Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Acute Pancreatitis: Treatment of Local Complication and Necrotizing Pancreatitis 韩国胰胆协会修订的急性胰腺炎临床实践指南:局部并发症和坏死性胰腺炎的治疗
Pub Date : 2022-01-31 DOI: 10.15279/kpba.2022.27.1.32
Y. Choi, Tae Hyeon Kim, H. Seo, S. Han
In severe acute pancreatitis, accompanied by local complications such as acute peripancreatic fluid collection, pancreatic pseudocyst, acute necrotic collection and walled-off necrosis, the mortality rate is as high as 12-25%. In many cases, interventional procedure or surgical treatment are required at an appropriate time. Conservative treatment is considered for acute peripancreatic fluid collection. Endoscopic drainage could be considered preferentially for the treatment of pancreatic pseudocysts with clinical symptoms or complications. In the case of necrotizing pancreatitis, conservative treatment is preferred, but therapeutic intervention should be considered if infectious pancreatic necrosis with clinical deterioration is suspected. For therapeutic intervention, it is recommended to proceed with a step-up approach in which drainage is first performed and, if necessary, necrosectomy is performed. The optimal timing of intervention is considered 4 weeks after the onset of pancreatitis when necrosis become walled-off, but early drainage within 4 weeks can be considered depending on the patient's condition. This guideline provides an overview of current treatment strategies for local complications of acute pancreatitis.
严重急性胰腺炎伴急性胰周液收集、胰腺假性囊肿、急性坏死收集、壁闭塞性坏死等局部并发症,死亡率可高达12-25%。在许多情况下,需要在适当的时候进行介入治疗或手术治疗。急性胰周积液可考虑保守治疗。对于有临床症状或并发症的胰腺假性囊肿,可优先考虑内镜下引流。对于坏死性胰腺炎,首选保守治疗,但若怀疑感染性胰腺坏死伴临床恶化,则应考虑进行治疗干预。对于治疗性干预,建议采用循序渐进的方法,首先进行引流,如有必要,进行坏死切除术。最佳干预时间为胰腺炎发病后4周,此时坏死已被壁闭塞,但可根据患者情况考虑在4周内早期引流。本指南概述了目前急性胰腺炎局部并发症的治疗策略。
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引用次数: 0
Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Acute Pancreatitis: Diagnosis 韩国胰胆协会修订急性胰腺炎临床实践指南:诊断
Pub Date : 2022-01-31 DOI: 10.15279/kpba.2022.27.1.6
M. Jung, D. Koh, Y. Cheon
There is general acceptance that a diagnosis of acute pancreatitis requires two of the following three features: 1) epigastric or upper abdominal pain characteristic of acute pancreatitis, 2) serum amylase and/or lipase ≥3 times the upper limit of normal, and 3) characteristic findings of acute pancreatitis on abdominal images such as ultrasonography, computed tomography (CT) or magnetic resonance imaging. Other pancreatic diseases and acute abdomen have been ruled out before making a diagnosis of acute pancreatitis. Serum lipase may be more useful than serum amylase because serum lipase is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis. Contrast-enhanced CT scan is the best imaging technique to rule out the conditions that masquerade as acute pancreatitis, to diagnose the severity of acute pancreatitis, and to identify complications of pancreatitis. The etiology of acute pancreatitis should be made clear as soon as possible to decide treatment policy of acute pancreatitis or to prevent the recurrence of pancreatitis. The etiology of acute pancreatitis in an emergency situation should be assessed by clinical history, laboratory tests such as serum liver function tests, measurement of serum calcium and serum triglycerides and ultrasonography. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because early endoscopic retrograde cholangiopancreatography should be considered if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected.
一般认为,诊断急性胰腺炎需要以下三个特征中的两个:1)急性胰腺炎特征性的上腹部或上腹部疼痛,2)血清淀粉酶和/或脂肪酶≥正常上限的3倍,3)腹部图像如超声、计算机断层扫描(CT)或磁共振成像显示急性胰腺炎的特征性表现。在诊断为急性胰腺炎之前,已经排除了其他胰腺疾病和急腹症。血清脂肪酶可能比血清淀粉酶更有用,因为在诊断急性胰腺炎时,血清脂肪酶被认为比血清淀粉酶更敏感和特异性。CT增强扫描是排除伪装为急性胰腺炎的情况、诊断急性胰腺炎严重程度、鉴别胰腺炎并发症的最佳成像技术。应尽早明确急性胰腺炎的病因,以确定急性胰腺炎的治疗策略或预防胰腺炎的复发。紧急情况下急性胰腺炎的病因应通过临床病史、实验室检查(如血清肝功能检查、血清钙和血清甘油三酯测量)和超声检查来评估。胆结石性急性胰腺炎的鉴别诊断应优先考虑其病因学诊断,因为如果怀疑有胆管炎和胆道延长通道障碍的并发症,应考虑早期内镜逆行胆管造影。
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引用次数: 1
Diagnosis and Management of Biliary Tract Cancer 胆道癌的诊断与治疗
Pub Date : 2022-01-31 DOI: 10.15279/kpba.2022.27.1.40
J. Yoon
Biliary tract cancer (BTC) are highly aggressive and fatal malignancies. As one of the leading cause of death in Republic of Korea, BTC amoung various malignancies has been one of major public health concerns in the country. Although BTCs, including intrahepatic, perihilar, and distal cholangiocarcinoma, are relatively low-incidence malignancies compared to other cancer, but they represent a major health problem in endemic areas like Korea and Asia contries; moreover, the incidence of intrahepatic cholangiocarcinoma is rising globally. Surgery is the only curative treatment. The optimal surgical approach depends on the anatomical site of the primary tumour, and the best outcomes are achieved through management by specialist multidisciplinary team. Unfortunately, most patients present with locally advanced or metastatic disease. Only up to 20% of patients are diagnosed in early-stage, suitable for the curative surgery. Despite the surgery performed with potentially-curative intent, recurrence rates are high, around 60-70% of patients expected to have disease recurrence. In this review, we present an update of the causes, diagnosis, and treatment with a focus on chemotherapy of BTC.
胆道癌(BTC)是高度侵袭性和致命性的恶性肿瘤。作为大韩民国的主要死亡原因之一,BTC在各种恶性肿瘤中一直是该国主要的公共卫生问题之一。尽管与其他癌症相比,包括肝内、门周和远端胆管癌在内的胆管癌是发病率相对较低的恶性肿瘤,但它们在韩国和亚洲国家等流行地区构成了一个主要的健康问题;此外,肝内胆管癌的发病率在全球范围内呈上升趋势。手术是唯一的治疗方法。最佳的手术方式取决于原发肿瘤的解剖部位,最好的结果是通过多学科专家团队的管理。不幸的是,大多数患者表现为局部晚期或转移性疾病。只有高达20%的患者在早期被诊断出来,适合进行治疗性手术。尽管手术具有潜在的治愈意图,但复发率很高,约60-70%的患者预计会复发。在这篇综述中,我们介绍了BTC的病因、诊断和治疗的最新进展,重点是化疗。
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引用次数: 0
Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Acute Pancreatitis: Purpose and Process of Guidelines 韩国胰胆协会修订的急性胰腺炎临床实践指南:指南的目的和过程
Pub Date : 2022-01-31 DOI: 10.15279/kpba.2022.27.1.1
J. Choe, S. Lee, Y. Cheon, Hong-Sik Lee, Miyoung Choi
Acute pancreatitis can range from a mild, self-limiting disease that requires no more than supportive care to severe disease with life-threatening complications. Therefore, to provide a framework for clinicians to manage acute pancreatitis and to improve national health care, the Korean Pancreatobiliary Association (KPBA) established the first Korean guideline for the management of acute pancreatitis in 2013. However, many challenging issues exist, which sometimes lead to differences in practice between clinicians. Taking together the recent dramatic changes of latest knowledge and evidence newly obtained, the committee of the KPBA decided to perform an extensive revision of the guidelines. These revised guidelines were developed by using mainly Delphi methods, and the main topics of these guidelines fall under the following topics: 1) diagnosis, 2) severity assessment, 3) initial treatment, nutritional support, and convalescent treatment, 4) the treatment of local complication and necrotizing pancreatitis. The specific recommendations are presented with the quality of evidence and classification of recommendations.
急性胰腺炎可以是一种轻微的自限性疾病,只需要支持性护理,也可以是严重的疾病,伴有危及生命的并发症。因此,为了给临床医生提供一个管理急性胰腺炎的框架,并改善国家卫生保健,韩国胰胆管协会(KPBA)于2013年制定了第一个韩国急性胰腺炎管理指南。然而,存在许多具有挑战性的问题,有时会导致临床医生之间的实践差异。综合最近最新知识和新获得的证据的巨大变化,KPBA委员会决定对指南进行广泛的修订。修订后的指南主要采用德尔菲法,主要内容包括:1)诊断,2)严重程度评估,3)初始治疗,营养支持,康复期治疗,4)局部并发症和坏死性胰腺炎的治疗。具体建议与证据的质量和建议的分类一起提出。
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引用次数: 0
Rapidly Growing Acinar Cell Carcinoma of the Pancreatic Head: A Case Report and Literature Review 胰头快速生长腺泡细胞癌1例报告及文献复习
Pub Date : 2022-01-31 DOI: 10.15279/kpba.2022.27.1.54
E. Kang, Y. Choi, Hyoung-Chul Oh, J. Do, S. Hong, Seung Eun Lee
Pancreatic acinar cell carcinoma (ACC) is a rare neoplasm accounting less than 1% of malignant pancreatic tumors. A 47-year-old male patient visited the emergency room with epigastric pain. Computed tomography or magnetic resonance imaging revealed a 4.7-cm heterogeneously enhanced solid and cystic mass with internal necrosis located in the head of the pancreas. Radiological diagnosis was borderline malignancy such as neuroendocrine tumor or solid pseudopapillary neoplasm. Two months later, the necrotic mass in the pancreas head had grown up to 11 cm, compressing the duodenum, superior mesenteric vein, and proximal transverse colon. Pylorus preserving pancreatoduodenectomy with segmental resection of transverse colon was performed. Histopathological examination revealed that the tumor was pancreatic ACC. The patient recovered without any complication and was doing well without recurrence for 12 months after surgery.
胰腺腺泡细胞癌(ACC)是一种罕见的肿瘤,占胰腺恶性肿瘤的不到1%。47岁男性患者因胃脘痛就诊急诊。计算机断层扫描或磁共振成像显示胰腺头部有一个4.7厘米的非均匀强化实性囊性肿块,伴有内部坏死。影像学诊断为交界性恶性肿瘤,如神经内分泌瘤或实性假乳头状瘤。两个月后,胰腺头坏死肿块长至11厘米,压迫十二指肠、肠系膜上静脉和近端横结肠。行保留幽门胰十二指肠切除术并横结肠节段切除。组织病理学检查显示肿瘤为胰腺ACC。术后12个月无复发,无并发症,恢复良好。
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引用次数: 0
Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Acute Pancreatitis: Severity Assessment 韩国胰胆协会修订的急性胰腺炎临床实践指南:严重程度评估
Pub Date : 2022-01-31 DOI: 10.15279/kpba.2022.27.1.12
J. Jo, D. Jang, S. Lee, M. Jung, Dong Ho Lee
The severity of acute pancreatitis (AP) is classified into mild, moderately severe, and severe, considering the presence and duration of organ failure and local complications. Since patients with AP show a large difference in mortality and morbidity according to AP severity, evaluation of the severity of patients with AP in the early stage is important for predicting the prognosis and determining treatment plans including transfer to the intensive care unit or advanced facilities. In order to evaluate the initial severity of AP, it is necessary to confirm the presence of organ failure and objective evaluation using imaging or clinical examinations. In this guideline, it is recommended that evaluation using various severity indices such as bedside index for severity in acute pancreatitis (BISAP), systemic inflammatory response syndrome (SIRS), and acute physiology and chronic health evaluation (APACHE)-II scores be considered.
急性胰腺炎(AP)的严重程度根据器官衰竭的存在和持续时间以及局部并发症分为轻度、中度和重度。由于AP患者的死亡率和发病率根据AP的严重程度有很大差异,因此早期评估AP患者的严重程度对于预测预后和确定包括转入重症监护病房或高级设施在内的治疗方案非常重要。为了评估AP的初始严重程度,有必要通过影像学或临床检查确认器官衰竭的存在和客观评价。在本指南中,建议考虑使用各种严重程度指标进行评估,如急性胰腺炎严重程度床边指数(BISAP)、全身炎症反应综合征(SIRS)和急性生理和慢性健康评估(APACHE)-II评分。
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引用次数: 0
Endoscopic Biliary Laser Ablation 内镜胆道激光消融
Pub Date : 2021-10-31 DOI: 10.15279/kpba.2021.26.4.260
Seok Jeong
담관계 국소 내시경 치료는 여러 암종에 의하여 발생하는 악성 담관 협착과 외과적 손상이나 만성 췌장염 등에 의하여 발생하는 양성 담관 협착이 주된 치료 대상이 된다. 이 두 질환은 임상에서 흔히 발생하며, 일부 환자에서는 치료에 대한 반응이 떨어지거나 협착의 재발이 발생하여 치료에 어려움이 따른다. 최근 국소 내시경 치료법 중 국소 내시경 담관 조직 절제술(local endoscopic biliary ablation)을 위한 다양한 국소 치료 기기들이 개발되었고, 이를 이용한 국소 내시경 담관 조직 절제술의 전임상 연구들이 진행되어 일부는 임상에 진입하여 의료기기 시장에 진출한 상태이다. 수년 전부터 레이저의 광에너지를 이용한 내시경 국소 담관 치료법이 개발되어 대동물에서의 전임상실험과 일부 임상 적용 사례가 보고된 바 있다. 본고에서는 내시경 담관 레이저 치료기기와 국소 치료법을 소개하고, 현재 연구 개발 진행 상황을 알아보고자 한다.
胆管局部内视镜治疗的主要治疗对象是由多种癌症引起的恶性胆管狭窄和外科损伤、慢性胰腺炎等引起的良性胆管狭窄。这两种疾病在临床上经常发生,一些患者对治疗的反应下降或狭窄复发,导致治疗困难。最近局部内窥镜治疗方法中局部内窥镜胆管组织切除术(local endoscopic biliary ablation)为开发了多种多样的局部治疗机器了,利用局部内窥镜胆管切除组织的前任上酒被进行了一些研究,进入临床医疗器械进入市场的状态。从数年前开始,利用激光光能的内视镜局部胆管治疗法被开发出来,在大物件上的前临床实验和部分临床应用事例被报告出来。本高中将介绍内视镜胆管激光治疗仪器和局部治疗方法,了解目前的研究开发进展情况。
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引用次数: 0
Endoscopic Ultrasound Guided Fine Needle Aspiration and Biopsy for Pancreatic Disease 内镜超声引导下胰腺疾病细针穿刺活检
Pub Date : 2021-10-31 DOI: 10.15279/kpba.2021.26.4.241
K. Lee
The endoscopic ultrasound (EUS) is a device with an ultrasound probe on the tip of endoscope. We can observe the surrounding structures outside the alimentary tract by using EUS. It is also possible to get a tissue from the pancreatic lesion for histopathologic diagnosis by using EUS. The development of devices and techniques of EUS guided tissue acquisitions made it the choice of non-operative pathologic test for pancreatic diseases. This paper describes the clinical applications of this procedure in pancreatic lesions from the recent European and Korean guidelines, including how to choose the needle, role of rapid on site evaluation, usage of stylet, suction and fanning technique, how to process acquired specimen, procedure-related complications and educations of this method.
超声内镜(EUS)是一种在内窥镜尖端装有超声探头的设备。我们可以通过EUS观察消化道外的周围结构。也可以通过EUS从胰腺病变处取组织进行组织病理学诊断。EUS引导下组织采集的设备和技术的发展使其成为胰腺疾病非手术病理检查的选择。本文从欧洲和韩国最新的指南中介绍了该方法在胰腺病变中的临床应用,包括如何选择针头,快速现场评估的作用,针柱的使用,吸引和扇风技术,如何处理获得的标本,手术相关的并发症以及该方法的教育。
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引用次数: 0
Novel Drug Screening Platform: Tumor Organoid 新型药物筛选平台:肿瘤类器官
Pub Date : 2021-10-31 DOI: 10.15279/kpba.2021.26.4.233
Ju Eun Maeng, H. Seo, Soon-Chan Kim, J. Ku
Pancreatic ductal adenocarcinoma (PDAC) is known to be one of the most lethal cancers among all cancer types, with a relative 5-year survival rate of less than 8%. Currently, surgery is the only probable curative treatment for PDAC which is available for only 10-15% of the patients diagnosed with the cancer. Organoids resemble the original tissue in morphology and function with self-organizing capacity. Organoids can be cultured with high effectiveness from individual patient derived tumor tissue which makes them an extremely fitting model for translational uses and the improvement of personalized cancer medicine. Before personalized medicine based on organoids can be applied in the clinic, the improvement of drug screening platforms in terms of sensitivity and robustness is necessary.
胰管腺癌(Pancreatic ductal adencarcinoma, PDAC)是所有癌症类型中最致命的癌症之一,其相对5年生存率不到8%。目前,手术是唯一可能治愈PDAC的治疗方法,但只有10-15%的患者被诊断患有这种癌症。类器官在形态和功能上与原始组织相似,具有自组织能力。类器官可以从个体患者来源的肿瘤组织中高效培养,这使它们成为翻译应用和个性化癌症医学改进的非常合适的模型。在基于类器官的个体化医疗应用于临床之前,药物筛选平台在敏感性和鲁棒性方面的改进是必要的。
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引用次数: 1
Introduction to the Rule Book of Pancreatobiliary Endoscopy Certification 胰胆道内窥镜检查认证规则手册简介
Pub Date : 2021-10-31 DOI: 10.15279/kpba.2021.26.4.224
W. Park
An endoscopic retrograde cholangiopancreatography (ERCP) procedure requires the highest level of difficulty among endoscopic procedures and the complications related to the procedure is relatively high, and fatal. Training in ERCP requires the development of technical, cognitive, and integrative skills well beyond those needed for standard endoscopic procedures. Therefore, a system that certifies qualifications through objective and systematic training and examination is needed to improve patient safety and quality of medical services. This manuscript introduces a set of rules that contain all the necessary matters for the certification system of pancreatic and biliary endoscopy.
内镜逆行胰胆管造影(ERCP)是内镜手术中难度最高的手术,其并发症也相对较高,甚至是致命的。ERCP的培训需要技术、认知和综合技能的发展,远远超出标准内窥镜手术的要求。因此,需要一个通过客观、系统的培训和考试来认证资格的制度,以提高患者的安全和医疗服务质量。本文介绍了一套规则,其中包含了胰腺和胆道内窥镜认证系统的所有必要事项。
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引用次数: 0
期刊
The Korean Journal of Pancreas and Biliary Tract
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