Chiang David T, Anozie Anthony, Fleming William R, Kiroff G K
Department of Surgery, The University of Melbourne, Victoria, Australia.
ANZ J Surg. 2004 Apr;74(4):218-21. doi: 10.1111/j.1445-2197.2004.02958.x.
Guidelines have been published regarding the management of acute pancreatitis by the British Society of Gastroenterology (BSG). The aim of the present paper is to compare the management of patients with acute pancreatitis in a tertiary referral medical centre and a regional health centre in Australia during 2001, evaluate compliance with the published BSG guidelines, and compare our data with those of a similar UK study.
Patients with a primary diagnosis of acute pancreatitis were identified retrospectively. Eighty-four admissions from the Austin Hospital (AH), a tertiary referral centre, and 83 from The Geelong Hospital (TGH), a regional health centre, were treated in these two hospitals. The histories were collected and examined for compliance with the guidelines recommended by the BSG. We compared our data with the data from the two UK hospitals in a previous study.
Only 38% of patients from these two centres had all the investigations performed for severity stratification as recommended by BSG. In other respects, AH and TGH managed these patients with acute pancreatitis according to the recommendations. The overall mortality rate from acute pancreatitis was 3.0%, and within the group of severe acute pancreatitis the mortality rate was 22.7%. 65.5% of patients from AH with gallstone related acute pancreatitis had a cholecystectomy or sphincterotomy and extraction of gallstones within 4 weeks of presentation. There were five re-admissions to AH in 2001 due to non-operated gallstone-related acute pancreatitis. In contrast, 84.3% of patients from TGH had definitive treatment within 4 weeks and there were three re-admissions to TGH.
Overall, both a tertiary referral centre and smaller regional hospital in Australia managed acute pancreatitis according to recently published BSG guidelines. The guidelines emphasized the importance of expertise in hepatopancreatobiliary surgery, availability of intensive care unit/high dependency unit and dynamic CT scanning. The recommendations for definitive treatment of patients with gallstone-related pancreatitis within 4 weeks of presentation reduced the morbidity and mortality in this group. Although compliance with the guidelines on investigation for severity stratification of acute pancreatitis was poor, this lack of formal severity assessment did not appear to influence the outcome.
英国胃肠病学会（BSG）已发布关于急性胰腺炎管理的指南。本文旨在比较2001年澳大利亚一家三级转诊医疗中心和一家地区健康中心对急性胰腺炎患者的管理情况，评估对已发布的BSG指南的依从性，并将我们的数据与英国一项类似研究的数据进行比较。
对原发性诊断为急性胰腺炎的患者进行回顾性识别。这两家医院分别治疗了来自三级转诊中心奥斯汀医院（AH）的84例入院患者和地区健康中心吉朗医院（TGH）的83例患者。收集病史并检查是否符合BSG推荐的指南。我们将我们的数据与之前一项研究中两家英国医院的数据进行了比较。
这两个中心只有38%的患者按照BSG的建议进行了所有用于严重程度分层的检查。在其他方面，AH和TGH根据建议对这些急性胰腺炎患者进行了管理。急性胰腺炎的总体死亡率为3.0%，在重症急性胰腺炎组中死亡率为22.7%。AH医院65.5%的胆石症相关性急性胰腺炎患者在就诊后4周内进行了胆囊切除术或括约肌切开取石术。2001年，AH医院有5例因未手术治疗的胆石症相关性急性胰腺炎再次入院。相比之下，TGH医院84.3%的患者在4周内接受了确定性治疗，TGH医院有3例再次入院。
总体而言，澳大利亚的一家三级转诊中心和较小的地区医院都根据最近发布的BSG指南管理急性胰腺炎。这些指南强调了肝胰胆外科专业知识、重症监护病房/高依赖病房的可用性以及动态CT扫描的重要性。在就诊后4周内对胆石症相关性胰腺炎患者进行确定性治疗的建议降低了该组的发病率和死亡率。尽管对急性胰腺炎严重程度分层检查指南的依从性较差，但这种缺乏正式严重程度评估的情况似乎并未影响结果。
