Neoptolemos J P, Carr-Locke D L, London N, Bailey I, Fossard D P
Department of Surgery, Leicester Royal Infirmary, Leicester General Hospital, UK.
Br J Surg. 1988 Oct;75(10):954-60. doi: 10.1002/bjs.1800751007.
A total of 131 patients with acute pancreatitis (of whom 100 had gallstones) underwent endoscopic retrograde cholangiopancreatography (ERCP) during the same hospital admission. Urgent ERCP (less than 72 h) was performed in 68 cases and early ERCP (3-30 days) in 63 cases; 47 had predicted severe attacks and 84 had predicted mild attacks (modified Glasgow criteria). The highest incidence of common bile duct stones occurred in those with predicted severe attacks and those who had urgent ERCP. Highly significant correlations were found between age and common bile duct and pancreatic duct diameters. Significant correlations were also found between the common bile duct and pancreatic duct (correcting for age) and between these and the admission serum bilirubin. The common bile duct diameter was greatest in those with common bile duct stones and predicted severe attacks. A considerably lower incidence of pancreatic duct filling occurred in those with predicted severe attacks and common bile duct stones; in predicted mild attacks the pancreatic duct diameter was greater in those with common bile duct stones. In gallstone patients complications were highest in those with predicted severe attacks but more significantly in those with common bile duct stones. Endoscopic sphincterotomy was undertaken in 37 patients with common bile duct stones without mortality. The overall complication rate in gallstone patients was 19 per cent and the mortality rate was 2 per cent. These findings suggest that common bile duct stones cause acute common bile duct and pancreatic duct obstruction and are closely associated with complications. Urgent ERCP for detection of common bile duct stones, and endoscopic sphincterotomy for treatment, is strongly recommended for patients with predicted severe attacks due to gallstones and should also be considered for others who fail to show clinical improvement.
共有131例急性胰腺炎患者（其中100例有胆结石）在同一次住院期间接受了内镜逆行胰胆管造影（ERCP）。68例患者进行了紧急ERCP（少于72小时），63例进行了早期ERCP（3 - 30天）；47例预计为重症发作，84例预计为轻症发作（改良格拉斯哥标准）。胆总管结石的最高发病率出现在预计为重症发作的患者以及接受紧急ERCP的患者中。发现年龄与胆总管及胰管直径之间存在高度显著的相关性。在胆总管与胰管之间（校正年龄后）以及它们与入院时血清胆红素之间也发现了显著的相关性。胆总管结石且预计为重症发作的患者，其胆总管直径最大。预计为重症发作且有胆总管结石的患者，胰管充盈的发生率明显较低；在预计为轻症发作的患者中，有胆总管结石的患者胰管直径更大。在胆结石患者中，预计为重症发作的患者并发症发生率最高，但有胆总管结石的患者更为显著。37例胆总管结石患者接受了内镜括约肌切开术，无死亡病例。胆结石患者的总体并发症发生率为19%，死亡率为2%。这些发现表明，胆总管结石会导致急性胆总管和胰管梗阻，并与并发症密切相关。强烈建议对预计因胆结石而重症发作的患者进行紧急ERCP以检测胆总管结石，并进行内镜括约肌切开术进行治疗，对于其他临床症状未改善的患者也应考虑进行该治疗。
