Neoptolemos J P, Carr-Locke D L, London N J, Bailey I A, James D, Fossard D P
Departments of Surgery, Leicester Royal Infirmary, Leicester.
Lancet. 1988 Oct 29;2(8618):979-83. doi: 10.1016/s0140-6736(88)90740-4.
121 patients with acute pancreatitis thought to be due to gallstones were randomised to treatment with urgent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) or with conventional treatment. They were stratified by predicted severity of the attack, according to the modified Glasgow system. ERCP was done within 72 h, and if common bileduct stones were identified, patients underwent ES immediately to extract the stones. There were fewer complications in the 59 patients who underwent ERCP +/- ES than among the 62 treated conventionally, the difference being confined to those whose attacks were predicted to be severe (6/25 ERCP +/- ES [1 death] compared with 17/28 conventional treatment [5 deaths]). Hospital stay was also shorter for patients with severe attacks who underwent ERCP +/- ES than for those who received conservative treatment (median 9.5 versus 17.0 days).
121名被认为是由胆结石引起急性胰腺炎的患者被随机分为两组，分别接受紧急内镜逆行胰胆管造影术（ERCP）及内镜括约肌切开术（ES）治疗或传统治疗。根据改良格拉斯哥系统，按照发作的预测严重程度对患者进行分层。ERCP在72小时内完成，如果发现胆总管结石，患者立即接受ES以取出结石。接受ERCP±ES治疗的59名患者比62名接受传统治疗的患者并发症更少，差异仅限于那些发作被预测为严重的患者（6/25接受ERCP±ES治疗[1例死亡]，相比之下17/28接受传统治疗[5例死亡]）。接受ERCP±ES治疗的严重发作患者的住院时间也比接受保守治疗的患者短（中位数分别为9.5天和17.0天）。
