Beth Israel Deaconess Medical Center, Boston, Massachusetts (A.T., S.D.F., T.K., H.L.).
Ann Intern Med. 2019 Feb 5;170(3):175-181. doi: 10.7326/M18-3536.
Acute pancreatitis, a common cause of hospitalization in the United States, is often the result of biliary tract disease. In 2016, the American Gastroenterological Association released a guideline that addresses the practical considerations in managing acute pancreatitis within the first 72 hours after the patient presents. The guideline specifically recommends goal-directed hydration therapy, early enteral feeding, judicious use of endoscopic retrograde cholangiopancreatography (ERCP), and gallbladder surgery during the index admission for patients with mild pancreatitis. The authors discuss their approach to these interventions in the context of a patient with recurrent acute pancreatitis who chooses to delay surgery until after hospital discharge. They address hydration and timing of surgery, as well as how they would manage the patient's preferences in the face of existing guidelines.
急性胰腺炎是美国常见的住院原因，通常是胆道疾病的结果。2016 年，美国胃肠病学会发布了一项指南，针对患者就诊后 72 小时内急性胰腺炎的管理提出了实际考虑因素。该指南特别建议对轻度胰腺炎患者进行目标导向的补液治疗、早期肠内营养、内镜逆行胰胆管造影（ERCP）的审慎使用以及胆囊切除术。作者根据一位选择在出院后进行手术的复发性急性胰腺炎患者的情况，讨论了他们对这些干预措施的处理方法。他们探讨了补液和手术时机，以及在面对现有指南的情况下，如何管理患者的偏好。
