Schwesinger W H, Page C P, Sirinek K R, Levine B A, Aust J B
Department of Surgery, University of Texas Health Science Center (UTHSC), San Antonio 78284-7842.
Arch Surg. 1991 Jul;126(7):836-9; discussion 839-40. doi: 10.1001/archsurg.1991.01410310046006.
To evaluate the efficacy of a selective approach to biliary pancreatitis, we reviewed the outcomes in 276 consecutive patients undergoing operations for this diagnosis during a 7-year period. Initial conservative therapy resulted in elective operations in 63% and urgent operations in 37%. Only 10 patients (3.6%) required primary pancreatic operations, 50% of them as emergencies. The proportion of common duct surgical explorations fell from 70% of those operated immediately after hospital admission to 20% by the third hospital day. Overall mortality was 1.8% but was increased to 30% in patients having an initial pancreatic operation. We conclude that a selective approach to biliary pancreatitis allows the operation to be performed electively in most patients and is associated with a low mortality and an acceptable length of stay. Most common duct stones pass spontaneously permitting cholecystectomy alone.
为评估选择性治疗胆源性胰腺炎的疗效，我们回顾了7年间连续276例因该诊断接受手术治疗患者的预后情况。初始保守治疗使63%的患者接受择期手术，37%的患者接受急诊手术。仅10例患者（3.6%）需要进行一期胰腺手术，其中50%为急诊手术。胆总管探查术的比例从入院后立即手术患者的70%降至住院第三天时的20%。总体死亡率为1.8%，但初始进行胰腺手术的患者死亡率增至30%。我们得出结论，选择性治疗胆源性胰腺炎可使大多数患者接受择期手术，且死亡率低、住院时间可接受。大多数胆总管结石可自行排出，仅行胆囊切除术即可。
