Badru Faidah, Saxena Saurabh, Breeden Robert, Bourdillon Maximillan, Fitzpatrick Colleen, Chatoorgoon Kaveer, Greenspon Jose, Villalona Gustavo
Department of Pediatric Surgery, Cardinal Glennon Children's Hospital, St. Louis, Missouri.
Department of Pediatric Surgery, Cardinal Glennon Children's Hospital, St. Louis, Missouri.
J Surg Res. 2017 Jul;215:225-230. doi: 10.1016/j.jss.2017.03.045. Epub 2017 Apr 7.
Little data exist regarding the recurrence of pancreatitis in pediatric patients with gallstone pancreatitis awaiting cholecystectomy. This study evaluates the recurrence rate of pancreatitis after acute gallstone pancreatitis based on the timing of cholecystectomy in pediatric patients.
A retrospective chart review of all patients admitted with gallstone pancreatitis from 2007 to 2015 was performed. Children were divided into the following five groups. Group 1 had surgery during the index admission. Group 2 had surgery within 2 wk of discharge. Group 3 had surgery between 2 and 6 wk postdischarge. Group 4 had surgery 6 wk after discharge, and group 5 patients had no surgery. The recurrence rates of pancreatitis were calculated for all groups.
Forty-eight patients with gallstone pancreatitis were identified in this study. The 19 patients in group 1 had no recurrence of their pancreatitis. Of the remaining 29 patients, nine (31%) had recurrence of pancreatitis or required readmission for abdominal pain prior to their cholecystectomy. In group 2, two of the eight patients (25%) had recurrent pancreatitis. In group 3, three of eight patients (37.5%) developed recurrent pancreatitis. In group 4, three of five patients (60%), and in group 5, one of eight. No children in group 5 had demonstrable gallstones at presentation, only sludge in their gallbladder.
Cholecystectomy during the index admission is associated with no recurrence or readmission for pancreatitis. Therefore, we recommend that cholecystectomy be performed after resolution of an episode of gallstone pancreatitis during index admission.
关于等待胆囊切除术的小儿胆石性胰腺炎患者胰腺炎复发的数据很少。本研究基于小儿患者胆囊切除术的时机评估急性胆石性胰腺炎后胰腺炎的复发率。
对2007年至2015年所有因胆石性胰腺炎入院的患者进行回顾性病历审查。儿童被分为以下五组。第1组在初次入院期间进行手术。第2组在出院后2周内进行手术。第3组在出院后2至6周进行手术。第4组在出院后6周进行手术，第5组患者未进行手术。计算所有组胰腺炎的复发率。
本研究共确定48例胆石性胰腺炎患者。第1组的19例患者胰腺炎未复发。其余29例患者中，9例（31%）在胆囊切除术之前胰腺炎复发或因腹痛需再次入院。第2组的8例患者中有2例（25%）胰腺炎复发。第3组的8例患者中有3例（37.5%）发生复发性胰腺炎。第4组的5例患者中有3例（60%），第5组的8例患者中有1例。第5组中无儿童在就诊时发现有明显胆结石，仅胆囊中有胆泥。
初次入院期间进行胆囊切除术与胰腺炎无复发或再次入院无关。因此，我们建议在初次入院期间胆石性胰腺炎发作缓解后进行胆囊切除术。
