在胆源性胰腺炎手术前或手术期间，导管评估是否总是必要的？

Is ductal evaluation always necessary before or during surgery for biliary pancreatitis?

作者信息

Ito Kaori, Ito Hiromichi, Tavakkolizadeh Ali, Whang Edward E

机构信息

Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.

出版信息

Am J Surg. 2008 Apr;195(4):463-6. doi: 10.1016/j.amjsurg.2007.04.017.

DOI:10.1016/j.amjsurg.2007.04.017

PMID:18304507

Abstract

BACKGROUND

Whether all patients undergoing cholecystectomy following an episode of biliary pancreatitis require direct common bile duct evaluation is controversial. We hypothesized such evaluation can be omitted safely among select patients at low risk for choledocholithiasis.

METHODS

One hundred forty-eight patients undergoing cholecystectomy for biliary pancreatitis (January 1995-December 2005) met the following inclusion criteria: (1) no preoperative endoscopic retrograde cholangiography (ERC) or endoscopic retrograde cholangiopancreatography (ERCP); (2) normal or decreasing liver function tests (LFTs) preoperatively; and (3) no ductal dilation on non-invasive preoperative imaging. Group I had intraoperative cholangiography (IOC, n = 27); group II did not (n = 121).

RESULTS

No differences between groups I and II were evident in postoperative retained-stone related events: recurrent pancreatitis (11% vs 8%, P = .7), cholangitis (0% in both groups), and asymptomatic LFT elevation (0% vs 3%, P > .99).

CONCLUSIONS

Direct ductal evaluation can be omitted safely in select patients undergoing cholecystectomy for biliary pancreatitis who are at low risk for choledocholithiasis.

摘要

背景

在胆源性胰腺炎发作后接受胆囊切除术的所有患者是否都需要直接评估胆总管存在争议。我们假设在胆总管结石风险较低的特定患者中可以安全地省略这种评估。

方法

1995年1月至2005年12月期间，148例因胆源性胰腺炎接受胆囊切除术的患者符合以下纳入标准：（1）术前未进行内镜逆行胆管造影（ERC）或内镜逆行胰胆管造影（ERCP）；（2）术前肝功能检查（LFT）正常或下降；（3）术前无创影像学检查未发现胆管扩张。第一组进行术中胆管造影（IOC，n = 27）；第二组未进行（n = 121）。