Bismar Hayan A, Al-Salamah Saleh M
Department of Surgery, Division of General Surgery, University Unit, Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia.
Saudi Med J. 2003 Jun;24(6):660-4.
To evaluate the efficacy, safety, and timing of laparoscopic cholecystectomy in the management of mild to moderate cases of acute biliary pancreatitis.
The medical records of 158 patients admitted to Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia (KSA) from July 1998 to December 2001 were retrospectively reviewed. Acute biliary pancreatitis was diagnosed in patients who presented with abdominal pain with serum amylase level 3 times the normal limits in the absence of hypercalcemia or hyperlipidemia and presence of gallstones on ultrasonography. Severity of the disease was assessed using Atlanta Symposium criteria. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 106 patients (74.6%) on selective basis. One hundred and eighteen patients underwent laparoscopic cholecystectomy after clinical and biochemical resolution of the attack. Standard 4 ports technique was used. Intraoperative and postoperative morbidity and mortality, and postoperative hospital stay were reported.
Laparoscopic cholecystectomy was performed in 118 patients and it was possible in 110 cases (93.2%) after 3-8 days of admission. Preoperative ERCP was performed in 106 patients of mild to moderate acute biliary pancreatitis and common duct stones were retrieved in 19 cases (18%). The procedure was converted to open in 8 cases (6.7%). Postoperative complications were nausea and vomiting in 10, atelectasis in 8, chest infection in 3, and prolonged ileus in 2. The wound complication occurred in 4. One patient who had bile leak due to cystic duct stump avulsion at CBD junction was treated by endoscopic sphincterotomy plus stenting and another patient had partial CBD injury repaired primarily over a T-tube. Mean postoperative hospital stay was 2.4 days. One patient died due to uncontrolled arrhythmia and heart failure.
Laparoscopic cholecystectomy can be safely performed for mild to moderate acute biliary pancreatitis after clinical and biochemical resolution of the attack during the same admission with acceptable morbidity and mortality rates. This strategy will lead to reducing the recurring acute biliary pancreatitis, number of admissions and hospital stay.
评估腹腔镜胆囊切除术治疗轻至中度急性胆源性胰腺炎的疗效、安全性及手术时机。
回顾性分析1998年7月至2001年12月在沙特阿拉伯王国利雅得利雅得医疗中心收治的158例患者的病历。急性胆源性胰腺炎的诊断依据为：患者出现腹痛，血清淀粉酶水平高于正常上限3倍，且无高钙血症或高脂血症，超声检查发现胆结石。采用亚特兰大研讨会标准评估疾病严重程度。106例患者（74.6%）根据具体情况接受了术前内镜逆行胰胆管造影（ERCP）。118例患者在临床和生化指标恢复正常后接受了腹腔镜胆囊切除术。采用标准的四孔技术。报告术中及术后的发病率、死亡率及术后住院时间。
118例患者接受了腹腔镜胆囊切除术，其中110例（93.2%）在入院3 - 8天后成功完成手术。106例轻至中度急性胆源性胰腺炎患者接受了术前ERCP，19例（18%）取出胆总管结石。8例（6.7%）手术转为开腹手术。术后并发症包括恶心呕吐10例、肺不张8例、肺部感染3例、肠梗阻延长2例。伤口并发症4例。1例因胆总管交界处胆囊管残端撕脱导致胆漏的患者接受了内镜括约肌切开术加支架置入治疗，另1例胆总管部分损伤患者在T管支撑下进行了一期修复。术后平均住院时间为2.4天。1例患者因心律失常和心力衰竭控制不佳死亡。
对于轻至中度急性胆源性胰腺炎，在本次住院期间临床和生化指标恢复正常后，可安全地进行腹腔镜胆囊切除术，发病率和死亡率可接受。该策略将减少复发性急性胆源性胰腺炎的发生、住院次数及住院时间。
