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Abstract(s)
Introdução: A Pancreatite Aguda está associada a quatro tipos de complicações locais, que se distinguem pela existência, ou não, de necrose pancreática, tempo de evolução e encapsulação da coleção. As Coleções Necróticas Agudas e Necrose Encapsulada ou Walled-off Necrosis estão associadas a pancreatite necrotizante, enquanto que as Coleções de Líquidas Pancreáticas Agudas e os Pseudoquistos estão associadas a pancreatite edematosa intersticial. Este trabalho pretendeu realizar uma revisão da literatura sobre quais as melhores abordagens terapêuticas destas complicações da pancreatite aguda, nomeadamente o tipo de intervenções médicas ou cirúrgicas adequadas, as indicações e o timing para realização das mesmas.
Material e métodos: Pesquisa de artigos no motor de busca PubMed, em língua inglesa, que incluíram uma análise.
Resultados: Da análise bibliográfica realizada, destacam-se técnicas endoscópicas (Drenagem Transmural Endoscópica e Necrosectomia Transmural Endoscópica), Drenagem Percutânea com Cateter e técnicas cirúrgicas minimamente invasivas (Desbridamento Retroperitoneal Vídeo-assistida) que, enquadradas numa “step-up approach”, se mostraram adequadas no tratamento destas coleções. A análise revelou também que, sempre que possível, as intervenções devem ser realizadas numa fase tardia da doença. Apesar de apresentarem vantagens significativas em relação à abordagem cirúrgica tradicional, esta continua válida para alguns casos específicos.
Conclusões: A abordagem terapêutica às complicações locais da Pancreatite Aguda depende do seu conteúdo necrótico, da sua localização, do seu tempo de evolução, da clínica que condicionam e do seu estado de infeção. Devido à variabilidade e complexidade dos casos, a decisão deve ser individualizada e multidisciplinar.
Introduction: Acute pancreatitis is associated with four types local complications, distinguished by the presence or not of pancreatic necrosis, time of evolution and encapsulation of the collection. Fluid Necrotic Collections and Walled-off Necrosis are associated with Necrotizing Pancreatitis, whereas Acute Necrotic Collections and Pseudocysts are associated with Interstitial Edematous Pancreatitis. This work aimed to review the literature on the best therapeutic approaches of these collections, specifically the type of medical or surgical interventions, the indications and the timing to perform them. Material and methods: Search for articles in English language on PubMed search engine, which included an analysis. Results: From the bibliographical analysis, techniques such as the Endoscopic techniques (Endoscopic Transmural Drainage and Endoscopic Transmural Necrosectomy), Percutaneous Drainage and minimally invasive surgical techniques (Video-Assisted Retroperitoneal Debridement), included in a step-up approach, shown to be appropriate in the management of these collections. The analysis also revealed that, when possible, interventions should be performed at a later stage of the disease. Although these techniques present significant advantages over the traditional surgical approach, some indications for this approach remain valid. Conclusions: The therapeutic approach to the local complications of acute pancreatitis depends on its necrotic content, its location, its time of evolution, the clinical condition and its state of infection. Due to the variability and complexity of the cases, the decision must be individualized and multidisciplinary.
Introduction: Acute pancreatitis is associated with four types local complications, distinguished by the presence or not of pancreatic necrosis, time of evolution and encapsulation of the collection. Fluid Necrotic Collections and Walled-off Necrosis are associated with Necrotizing Pancreatitis, whereas Acute Necrotic Collections and Pseudocysts are associated with Interstitial Edematous Pancreatitis. This work aimed to review the literature on the best therapeutic approaches of these collections, specifically the type of medical or surgical interventions, the indications and the timing to perform them. Material and methods: Search for articles in English language on PubMed search engine, which included an analysis. Results: From the bibliographical analysis, techniques such as the Endoscopic techniques (Endoscopic Transmural Drainage and Endoscopic Transmural Necrosectomy), Percutaneous Drainage and minimally invasive surgical techniques (Video-Assisted Retroperitoneal Debridement), included in a step-up approach, shown to be appropriate in the management of these collections. The analysis also revealed that, when possible, interventions should be performed at a later stage of the disease. Although these techniques present significant advantages over the traditional surgical approach, some indications for this approach remain valid. Conclusions: The therapeutic approach to the local complications of acute pancreatitis depends on its necrotic content, its location, its time of evolution, the clinical condition and its state of infection. Due to the variability and complexity of the cases, the decision must be individualized and multidisciplinary.
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Keywords
Abordagem Complicações Locais Pancreatite Aguda