Arendt R, Liebe S, Erdmann K
Abteilung für Gastroenterologie Wilhelm-Pieck-Universität Rostock.
Z Gesamte Inn Med. 1989 Jul 1;44(13):401-4.
According to current knowledge biliary (gallstone-associated) acute pancreatitis is induced by transient obstruction of the papilla by migrating gall stones. It seems, therefore, rational to remove the occluding stone as early as possible by endoscopic papillotomy (EPT). Uncontrolled studies have shown that patients with acute pancreatitis are not more endangered by EPT than those without pancreatitis and that the intervention seems to beneficially influence the course of the pancreatic disease. Early endoscopy (within 48 h), however, revealed incarcerated papillary stones only in 10% but common bile ducts free of stones in 24%. There seems to be only a small subgroup with acute biliary pancreatitis who might benefit from early EPT. This subgroup should be characterized more precisely. Early EPT indiscriminately performed in any kind of acute pancreatitis has little rational ground and is, up to now, not justified.
根据目前的认识，胆源性（与胆结石相关的）急性胰腺炎是由移动的胆结石短暂阻塞乳头引起的。因此，尽早通过内镜乳头切开术（EPT）取出阻塞性结石似乎是合理的。非对照研究表明，急性胰腺炎患者接受EPT并不比未患胰腺炎的患者面临更大的风险，而且该干预措施似乎对胰腺疾病的病程有有益影响。然而，早期内镜检查（48小时内）发现，仅10%的患者存在嵌顿性乳头结石，而24%的患者胆总管无结石。似乎只有一小部分急性胆源性胰腺炎患者可能从早期EPT中获益。应该更精确地界定这一亚组。在任何类型的急性胰腺炎中不加区分地进行早期EPT缺乏合理依据，而且到目前为止是不合理的。
