Bertolín-Bernades Rosa, Sabater-Ortí Luis, Calvete-Chornet Julio, Camps-Vilata Bruno, Cassinello-Fernández Norberto, Oviedo-Bravo Miguel, Monco Purificación Ivorra-García, Cánovas-de Lucas Raúl, Lledó-Matoses Salvador
Department of Surgery, Hospital Clinico, University of Valencia, Avda Blasco Ibañez, no. 17, 46010 Valencia, Spain.
J Gastrointest Surg. 2007 Jul;11(7):875-9. doi: 10.1007/s11605-007-0148-5.
The rate of choledocholithiasis at the time of elective surgery after mild acute biliary pancreatitis is still unclear because it decreases rapidly after the onset. The aims of this study are as follows: (1) To investigate whether the incidence of choledocholithiasis in mild biliary pancreatitis is higher than in patients with symptomatic cholelithiasis. (2) To evaluate the usefulness of intraoperative cholangiography in the diagnosis of unsuspected choledocholithiasis in mild pancreatitis. Prospective study including 130 patients undergoing laparoscopic surgery and classified into two groups: mild biliary pancreatitis (n = 44) and symptomatic cholelithiasis (n = 86). Choledocholithiasis was evaluated by endoscopic cholangiopancreatography, magnetic resonance, and intraoperative cholangiography. Preoperatively, choledocholithiasis was identified in five patients with symptomatic cholelithiasis and two with biliary pancreatitis (5.81 vs 4.54%; p = 0.472). In 117 cases (90%), intraoperative cholangiography was successfully performed, identifying unsuspected choledocholithiasis in five patients of the colelithiasis group and in three in the group of pancreatitis (5.81 vs 6.81%; p = 0.492). The total number of patients with choledocholithiasis in the whole series was 15 (11.5%); 11.6% in colelithiasis group vs 11.4% in biliary pancreatitis group; p = 0.605. The rate of choledocholithiasis was not significantly different between the groups of patients with mild acute biliary pancreatitis and symptomatic cholelithiasis. Intraoperative cholangiography identified unsuspected choledocholithiasis in 6.81% of patients with mild acute biliary pancreatitis.
轻度急性胆源性胰腺炎后择期手术时胆总管结石的发生率仍不明确，因为其在发病后迅速下降。本研究的目的如下：（1）调查轻度胆源性胰腺炎患者胆总管结石的发生率是否高于有症状胆结石患者。（2）评估术中胆管造影在诊断轻度胰腺炎中未被怀疑的胆总管结石的实用性。前瞻性研究纳入130例行腹腔镜手术的患者，分为两组：轻度胆源性胰腺炎组（n = 44）和有症状胆结石组（n = 86）。通过内镜逆行胰胆管造影、磁共振成像和术中胆管造影评估胆总管结石。术前，在86例有症状胆结石患者中有5例、44例胆源性胰腺炎患者中有2例被发现有胆总管结石（5.81%对4.54%；p = 0.472）。117例（90%）成功进行了术中胆管造影，在胆结石组5例患者和胰腺炎组3例患者中发现了未被怀疑的胆总管结石（5.81%对6.81%；p = 0.492）。整个系列中胆总管结石患者总数为15例（11.5%）；胆结石组为11.6%，胆源性胰腺炎组为11.4%；p = 0.605。轻度急性胆源性胰腺炎患者组和有症状胆结石患者组之间胆总管结石的发生率无显著差异。术中胆管造影在6.81%的轻度急性胆源性胰腺炎患者中发现了未被怀疑的胆总管结石。
