Oría A, Frider B, Alvarez J, Chiappetta L, Souto N, Fontana J J
Department of Surgery, Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina.
Int J Pancreatol. 1988 Mar;3(2-3):157-64. doi: 10.1007/BF02798927.
A prospective study on biliary and pancreatic obstruction during gallstone migration was performed in patients without acute pancreatitis. From January to October 1986, 125 patients with upper abdominal pain due to cholelithiasis were admitted to the hospital. Ultrasonography performed in all patients at admission demonstrated a distal bile duct measuring 7 mm or more in 39 patients, who were monitored for diameter changes of the biliary and pancreatic duct every 24 h and their stools screened for gallstones. Patients underwent surgery at least 8 days after admission. Gallstone migration was found preoperatively in 10 patients, of whom 6 had total serum bilirubin values lower than 2 mg/100 ml. Migration time was accurately determined by the sudden decrease in bile duct caliber. Simultaneous dilatation of biliary and pancreatic duct was found in 4 out of 10 patients with migrating gallstones and in 7 out of 23 patients without gallstone migration, though differences proved non-significant. Acute pancreatitis developed in 2 patients with lithiasis of the distal bile duct who ingested a fatty meal against medical advice. Gallstone migration, even of small stones, was preceded by a period of biliary obstruction. Pain and jaundice before migration were not as frequent as expected.
在无急性胰腺炎的患者中开展了一项关于胆结石移动过程中胆管和胰腺梗阻的前瞻性研究。1986年1月至10月，125例因胆石症出现上腹部疼痛的患者入院。所有患者入院时均行超声检查，其中39例显示远端胆管直径达7mm或以上，对这些患者每24小时监测胆管和胰管直径变化，并检查粪便中的胆结石。患者入院至少8天后接受手术。术前发现10例胆结石移动，其中6例血清总胆红素值低于2mg/100ml。通过胆管口径突然减小准确确定移动时间。10例有胆结石移动的患者中有4例以及23例无胆结石移动的患者中有7例出现胆管和胰管同时扩张，不过差异无统计学意义。2例远端胆管结石患者不听医嘱进食油腻食物后发生急性胰腺炎。胆结石移动，即使是小结石移动，之前也会有一段胆管梗阻期。移动前的疼痛和黄疸并不像预期的那么频繁。
