Service de chirurgie digestive, oncologique, endocrinienne et transplantation hépatique, université François Rabelais, hôpital Trousseau, Centre Hospitalier Universitaire de Tours, 37170 Tours, France.
Service de chirurgie digestive, oncologique, endocrinienne et transplantation hépatique, université François Rabelais, hôpital Trousseau, Centre Hospitalier Universitaire de Tours, 37170 Tours, France.
J Visc Surg. 2019 Apr;156(2):113-125. doi: 10.1016/j.jviscsurg.2018.08.002. Epub 2018 Oct 30.
Acute pancreatitis is a frequent pathology with 11,000 to 13,000 new cases per year in France. A biliary origin (30 to 70% of the cases) should be suspected when alanine amino-transferases are elevated during the first 48 hours, and it is confirmed by the presence of gallstones at trans abdominal ultrasound. Abdominal computed-tomography scan is performed around the fifth day, and is repeated according to clinical and biological evolution. Management of acute biliary pancreatitis varies according to its severity, which should be assessed according to systemic inflammatory response syndrome and organ failures. For mild acute pancreatitis, cholecystectomy should be performed during in-hospital stay, before oral feeding. For moderately severe and severe acute pancreatitis, treatment is based on resuscitation, early enteral continuous feeding, and management of complications. Interval cholecystectomy is performed at a later stage. Endoscopic retrograde cholangiopancreatography with sphincterotomy should be performed in emergency when angiocholitis is associated, and in delayed emergency before oral feeding for persistent common bile duct stone. A common bile duct stone should be searched for during cholecystectomy and can be treated during the same surgical procedure if local conditions are adequate. Cholelithiasis is the most frequent cause of acute pancreatitis during pregnancy, and its diagnosis and the treatment have some particularities.
急性胰腺炎是一种常见的疾病，法国每年有 11000 至 13000 例新发病例。当丙氨酸氨基转移酶在最初 48 小时内升高时，应怀疑存在胆源性（30%至 70%的病例），并通过腹部超声检查发现胆结石来确认。腹部计算机断层扫描（CT 扫描）在第 5 天左右进行，并根据临床和生物学演变进行重复。急性胆源性胰腺炎的治疗方法因严重程度而异，应根据全身炎症反应综合征和器官衰竭进行评估。对于轻度急性胰腺炎，应在住院期间、开始口服进食前进行胆囊切除术。对于中度和重度急性胰腺炎，治疗基于复苏、早期肠内持续喂养以及并发症的管理。间隔期进行胆囊切除术。当存在胆管炎时，应紧急进行内镜逆行胰胆管造影术（ERCP）并进行括约肌切开术，对于持续存在的胆总管结石，应在开始口服进食前进行延迟紧急 ERCP。在胆囊切除术中应寻找胆总管结石，如果局部条件允许，可以在同一手术过程中进行治疗。胆石症是妊娠期急性胰腺炎最常见的原因，其诊断和治疗有一些特殊性。
