Pak J Med Sci. 2014 May;30(3):601-5. doi: 10.12669/pjms.303.4380.
Acute gallstone pancreatitis is quite common throughout the globe. Conventionally definitive cholecystectomy has been delayed in index hospital admission. Since the last decade timing of cholecystectomy is gradually shifting towards the earlier phase of disease and currently gallstone pancreatitis is being evaluated as a further indication for laparoscopic cholecystectomy. There is also great concern regarding compliance of patients for definitive surgery due to poverty, ignorance and illiteracy in developing countries. The aim of this study was to assess the feasibility and safety of laparoscopic cholecystectomy as a definitive treatment in patients with mild and resolving gall stone pancreatitis.
This was a prospective study from July 2009 to June 2012. Patients were diagnosed by clinical examination, biochemical tests, ultrasonography and contrast enhanced CT. Patients with mild form of the disease (Ranson Score ≤3) and who showed clinical improvement were offered laparoscopic cholecystectomy in index hospital admission. Those who were unfit for surgery were referred for endoscopic sphincterotomy. Common bile duct stones were excluded preoperatively.
A total of 38 patients were admitted with acute gallstone pancreatitis in the study period. The mean age of patients was 46.3 years with male to female ratio of 11/27. 22 (57.8%) patients were selected for laparoscopic cholecystectomy and procedure was completed successfully. Ten (26.3%) patients were referred for ERCP and endoscopic sphincterotomy and 11 (28.9%) were managed by conservative treatment and went without any definitive treatment. Mean duration of time from onset of symptoms and laparoscopic cholecystectomy was 7 days (range 4-10). Mean duration of operative time was 45 minutes and hospital stay was 7 days. There was no operative mortality. No major intra-operative or post-operative complication was recorded. two patients (9%) had minor complications.
Laparoscopic cholecystectomy can be safely performed in selected cases of mild gallstone pancreatitis in order to prevent further attacks of acute pancreatitis and other consequences of delayed treatment. Furthermore it resolves the problem of noncompliance of patients in third world countries where many patients are lost for definitive treatment.
急性胆石性胰腺炎在全球范围内都很常见。传统上，在索引住院期间，胆囊切除术被延迟。自过去十年以来，胆囊切除术的时机逐渐向疾病的早期阶段转移，目前胆石性胰腺炎被评估为腹腔镜胆囊切除术的进一步适应证。由于贫困、无知和发展中国家的文盲，患者对确定性手术的依从性也存在很大的担忧。本研究旨在评估腹腔镜胆囊切除术作为轻度和缓解性胆石性胰腺炎患者确定性治疗的可行性和安全性。
这是一项从 2009 年 7 月至 2012 年 6 月的前瞻性研究。患者通过临床检查、生化检查、超声检查和对比增强 CT 进行诊断。患有轻度疾病（Ranson 评分≤3）且临床表现改善的患者在索引住院期间接受腹腔镜胆囊切除术。那些不适合手术的患者被转诊行内镜下括约肌切开术。术前排除胆总管结石。
在研究期间，共有 38 例急性胆石性胰腺炎患者入院。患者的平均年龄为 46.3 岁，男女比例为 11/27。22 例（57.8%）患者选择行腹腔镜胆囊切除术，手术均成功完成。10 例（26.3%）患者转至 ERCP 和内镜下括约肌切开术，11 例（28.9%）患者接受保守治疗，未进行任何确定性治疗。从症状发作到腹腔镜胆囊切除术的平均时间为 7 天（范围 4-10 天）。手术时间平均为 45 分钟，住院时间为 7 天。无手术死亡。无重大术中或术后并发症记录。2 例（9%）患者出现轻微并发症。
在选择的轻度胆石性胰腺炎病例中，腹腔镜胆囊切除术可以安全进行，以防止急性胰腺炎的再次发作和延迟治疗的其他后果。此外，它解决了第三世界国家许多患者无法接受确定性治疗的问题。
