Filipovic Jaksa, Bekavac-Beslin Miroslav, Virovic Lucija, Supanc Vladimir, Zovak Mario, Hrabar Davor, Druzijanic Nikica
Department of Surgery, Sestre Milosrdnice University Hospital, Zagreb, Croatia.
Hepatogastroenterology. 2005 Sep-Oct;52(65):1364-7.
We report a case of a 52-year-old man admitted to our hospital because of acute biliary pancreatitis caused by cholelithiasis. The patient also had choledocholithiasis complicated with pancreatic pseudocyst. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and a large number of common bile duct stones were extracted with Dormia basket upon papillotomy. Pancreatic pseudocyst as a major complication of acute pancreatitis was also managed endoscopically by transpapillary stenting. Laparoscopic cholecystectomy with choledochotomy and choledochoscopy was performed for the final removal of biliary stones. Postoperative subhepatic abscess was resolved by ultrasound-guided percutaneous drainage. In this case biliary pancreatitis with all its complications was treated through minimally invasive endoscopic, percutaneous and surgical procedures. Minimally invasive techniques are much better because they reduce surgical stress, caused by reduction of flow through the splanchnic, which can also be reinforced by general endotracheal anesthesia. In the case when relative hypoxia occurs and acute serous pancreatitis transfers to acute necrotic pancreatitis, minimally invasive technique is the first and the best choice for surgical procedure.
我们报告一例52岁男性因胆石症引起急性胆源性胰腺炎入住我院。该患者还患有胆总管结石并伴有胰腺假性囊肿。进行了内镜逆行胰胆管造影（ERCP），在乳头切开术后用多尔米亚网篮取出了大量胆总管结石。胰腺假性囊肿作为急性胰腺炎的主要并发症，也通过经乳头支架置入术进行了内镜治疗。为最终清除胆管结石，实施了腹腔镜胆囊切除术、胆总管切开术和胆道镜检查。术后肝下脓肿通过超声引导下经皮引流得以解决。在此病例中，伴有所有并发症的胆源性胰腺炎通过微创内镜、经皮和外科手术进行了治疗。微创技术更好，因为它们减少了内脏血流减少所导致的手术应激，全身气管内麻醉也可增强这种效果。在发生相对缺氧且急性浆液性胰腺炎转变为急性坏死性胰腺炎的情况下，微创技术是手术的首选且最佳选择。
