Lee Jun Kyu, Ryu Ji Kon, Park Joo Kyung, Yoon Won Jae, Lee Sang Hyub, Hwang Jin-Hyeok, Kim Yong-Tae, Yoon Yong Bum
Department of Internal Medicine, Dongguk University International Hospital, Dongguk University College of Medicine, Goyang, Korea.
Hepatogastroenterology. 2008 Nov-Dec;55(88):1981-5.
BACKGROUND/AIMS: We evaluated the natural course of biliary pancreatitis and compared the results obtained using endoscopic sphincterotomy (EST) and cholecystectomy.
The medical records of 113 patients with biliary pancreatitis between January 1990 and April 2005 were analyzed retrospectively.
Twenty-five patients received no treatment and 15 (60.0%) of these experienced recurrence during a mean follow-up period of 36.0 months. Fifty-two received EST only, and no recurrence occurred during a mean follow-up of 29.8 months. Thirty-six patients underwent cholecystectomy and 1 (2.8%) patient experienced the second attack during a follow-up of 35.2 months. Acute cholecystitis developed in 7 of 77 (9.1%) patients who did not receive cholecystectomy during a mean follow-up period of 33.3 months, and was found to be prone to develop in patients with both gall bladder (GB) and common bile duct (CBD) stones.
Sixty percent of patients with biliary pancreatitis experienced relapses without treatment, and cholecystectomy with or without EST tended to reduce recurrence. Cholecystectomy might not be a routine treatment after EST especially in the old because the incidence of acute cholecystitis was relatively low within 3 years and be recommended for patients with both visible GB and CBD stones at presentation.
背景/目的：我们评估了胆源性胰腺炎的自然病程，并比较了内镜括约肌切开术（EST）和胆囊切除术的治疗结果。
回顾性分析1990年1月至2005年4月期间113例胆源性胰腺炎患者的病历。
25例患者未接受治疗，其中15例（60.0%）在平均36.0个月的随访期内复发。52例仅接受了EST治疗，在平均29.8个月的随访期内无复发。36例患者接受了胆囊切除术，1例（2.8%）患者在35.2个月的随访期内出现了第二次发作。在平均33.3个月的随访期内，77例未接受胆囊切除术的患者中有7例（9.1%）发生了急性胆囊炎，发现胆囊（GB）和胆总管（CBD）均有结石的患者更容易发生。
60%的胆源性胰腺炎患者未经治疗会复发，胆囊切除术无论是否联合EST都倾向于减少复发。EST后胆囊切除术可能不是常规治疗，尤其是在老年患者中，因为急性胆囊炎的发生率在3年内相对较低，对于就诊时胆囊和胆总管均有明显结石的患者建议行胆囊切除术。
