Neoptolemos J P
Department of Surgery, Leicester Royal Infirmary.
Ann R Coll Surg Engl. 1989 Sep;71(5):326-31.
There have been uncertainties as to the role of common bile duct (CBD) stones in severe gallstone pancreatitis. In order to resolve this, ERCP findings in 131 patients with acute pancreatitis were compared with predicted severity, clinical course and final outcome. Significant associations were found between 'persisting' CBD stones, coincidental acute cholangitis, predicted severity and actual outcome. There was evidence for acute obstruction of both the CBD and the pancreatic duct by CBD stones. The theory was therefore proposed that small migrating stones tend to initiate the attack, whereas larger 'persisting' stones tend to convert a mild attack into a severe attack. This hypothesis resolves previously irreconcilable theories and lends support to the use of urgent endoscopic sphincterotomy for treatment, but only in cases predicted to be severe.
关于胆总管（CBD）结石在重症胆石性胰腺炎中的作用一直存在不确定性。为了解决这一问题，对131例急性胰腺炎患者的内镜逆行胰胆管造影（ERCP）结果与预测的严重程度、临床病程及最终结局进行了比较。发现“持续存在的”胆总管结石、并发急性胆管炎、预测的严重程度与实际结局之间存在显著关联。有证据表明胆总管结石可导致胆总管和胰管的急性梗阻。因此提出理论，即小的移动性结石倾向于引发发作，而较大的“持续存在的”结石倾向于将轻度发作转变为重度发作。这一假说解决了先前无法调和的理论，并支持仅在预测为重症的病例中使用紧急内镜括约肌切开术进行治疗。
