Bouillot J L, Alexandre J H
Clinique chirurgicale, hôpital Broussais, Paris.
J Chir (Paris). 1987 Oct;124(10):509-14.
Retrospective analysis of a homogeneous group of 48 patients admitted with acute pancreatitis of biliary origin showed that 60% were in a serious condition. A total of 41 patients were operated upon, 25 in the early stages, 13 within a month, and 3 at some time after the acute episode. Lithiasis of the common bile duct was detected in 48, 23 and 33% of cases respectively; 9 calculi were enclaved including 7 in the early operated group. Cholecystectomy was combined with external drainage in 24 cases, choledocho-duodenal anastomosis in 3 and sphincterectomy in one; surgery to pancreas was necessary 17 times (necrosectomy in 13 and pancreatectomy in 4). 3 patients received endoscopic treatment and 4 were not operated upon. Ten patients died, including 8 in the early operated group. A literature review suggests that operation should be deferred (10th day), reducing severity of immediate surgery and avoiding risk of short or long term recurrence. The place of endoscopic sphincterectomy, notably in severe forms, has not been established.
对48例因胆源性急性胰腺炎入院的同类患者进行回顾性分析发现，60%的患者病情严重。共有41例患者接受了手术，其中25例在早期进行，13例在一个月内进行，3例在急性发作后的某个时间进行。分别在48%、23%和33%的病例中检测到胆总管结石；发现9颗结石嵌顿，其中7颗在早期手术组。24例行胆囊切除术并加外引流，3例行胆总管十二指肠吻合术，1例行括约肌切除术；17次需要对胰腺进行手术（13次坏死组织切除术，4次胰腺切除术）。3例患者接受了内镜治疗，4例未手术。10例患者死亡，其中8例在早期手术组。文献综述表明，手术应推迟到第10天，以降低即刻手术的严重程度，并避免短期或长期复发的风险。内镜括约肌切除术的地位，尤其是在重症患者中的地位，尚未确立。
