Winslet M C, Imray C, Neoptolemos J P
University Department of Surgery, Dudley Road Hospital, Birmingham, U.K.
Hepatogastroenterology. 1991 Apr;38(2):120-3.
Severe biliary acute pancreatitis is frequently associated with persisting bile duct stones, which has important implications with regard to management. In mild cases, cholecystectomy with operative cholangiography during the same admission is the treatment of choice. In patients with a severe attack, however, management remains controversial. There is increasing evidence to suggest that early biliary decompression with endoscopic sphincterotomy is associated with a lower morbidity and mortality than a conservative regime. In certain situations endoscopic sphincterotomy may also obviate the need to explore the common bile duct, and in high-risk patients may allow surgery to be avoided altogether.
重症胆源性急性胰腺炎常与持续性胆管结石相关，这对治疗具有重要意义。在轻症病例中，同期入院行胆囊切除术及术中胆管造影是首选治疗方法。然而，对于重症发作的患者，治疗仍存在争议。越来越多的证据表明，与保守治疗相比，早期内镜括约肌切开术进行胆管减压可降低发病率和死亡率。在某些情况下，内镜括约肌切开术还可避免探查胆总管，对于高危患者甚至可完全避免手术。
