Heider T Ryan, Brown Alphonso, Grimm Ian S, Behrns Kevin E
Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina, Chapel Hill, USA.
J Gastrointest Surg. 2006 Jan;10(1):1-5. doi: 10.1016/j.gassur.2005.10.009.
Patients with moderately severe gallstone pancreatitis with substantial pancreatic and peripancreatic inflammation, but without organ failure, frequently have an open cholecystectomy to prevent recurrent pancreatitis. In these patients, prophylactic endoscopic retrograde cholangiography (ERC) with endoscopic sphincterotomy (ES) may prevent recurrent pancreatitis, permit laparoscopic cholecystectomy, and decrease risks. The medical records of all patients with pancreatitis undergoing cholecystectomy from 1999-2004 at the University of North Carolina Memorial Hospital were reviewed. Data regarding demographics, clinical course, etiology of pancreatitis, operative and endoscopic interventions, and outcome were extracted. Moderately severe gallstone-induced pancreatitis was defined as pancreatitis without organ failure but with extensive local inflammation. Thirty patients with moderately severe gallstone pancreatitis underwent ERC and ES and were discharged before cholecystectomy. Mean interval between ES and cholecystectomy was 102 +/- 17 days. Cholecystectomy was performed laparoscopically in 27 (90%) patients, open in three (10%) patients, and converted to open in two (7%) patients, with a morbidity rate of 7% (two patients). No patient required drainage of a pseudocyst or developed recurrent pancreatitis. Interval complications resulted in hospital readmission in seven (23%) patients. In conclusion, recurrent biliary pancreatitis in patients with moderately severe gallstone pancreatitis is nil after ERC and ES. Hospital discharge of these patients permits interval laparoscopic cholecystectomy, but close follow-up is necessary in these potentially ill patients.
患有中度严重胆结石性胰腺炎且伴有大量胰腺及胰周炎症但无器官功能衰竭的患者，常常接受开腹胆囊切除术以预防胰腺炎复发。对于这些患者，预防性内镜逆行胰胆管造影术（ERC）联合内镜括约肌切开术（ES）可能预防胰腺炎复发，允许进行腹腔镜胆囊切除术，并降低风险。回顾了1999年至2004年在北卡罗来纳大学纪念医院接受胆囊切除术的所有胰腺炎患者的病历。提取了有关人口统计学、临床病程、胰腺炎病因、手术及内镜干预措施以及结局的数据。中度严重胆结石性胰腺炎定义为无器官功能衰竭但伴有广泛局部炎症的胰腺炎。30例中度严重胆结石性胰腺炎患者接受了ERC和ES，并在胆囊切除术前行出院。ES与胆囊切除术之间的平均间隔时间为102±17天。27例（90%）患者接受了腹腔镜胆囊切除术，3例（10%）患者接受了开腹手术，2例（7%）患者中转开腹，发病率为7%（2例患者）。无患者需要假性囊肿引流或发生胰腺炎复发。间隔期并发症导致7例（23%）患者再次入院。总之，中度严重胆结石性胰腺炎患者在接受ERC和ES后复发性胆源性胰腺炎为零。这些患者出院后可进行间隔期腹腔镜胆囊切除术，但对这些潜在患病患者进行密切随访是必要的。
