Prorok J J, Trostle D R
Am Surg. 1986 Apr;52(4):201-4.
Since the natural history of pancreatitis associated with cholelithiasis is one of recurrence, surgery for the biliary tract disease is mandatory. But appropriate timing of the surgery remains controversial. Seventy-eight patients have been treated with early surgery once a diagnosis of cholelithiasis associated pancreatitis was made. Eighteen patients had previous episodes of nonalcoholic pancreatitis. Utilizing Ranson's prognostic signs, 52 patients had mild pancreatitis and 26 severe. Sixty-eight patients (87%) had surgery within 72 hours after admission and ten patients (13%) within 5 days. All patients had a cholecystectomy and operative cholangiogram performed. Fifty-six (72%) positive operative cholangiograms were obtained and common bile duct exploration revealed choledocholithiasis in 42 patients (75%). No mortality occurred, and four had six complications including mild persistent pancreatitis (two), wound infection (one), urinary tract infection (one), cardiac arrhythmia (one) and heart block requiring permanent pacemaker (one). The average hospital stay was 10.4 days. T-tube cholangiogram done prior to discharge was normal in all patients, and there have been no episodes of recurrent pancreatitis. Early definitive surgery for pancreatitis associated with cholelithiasis is recommended and can be accomplished with minimal morbidity and mortality coupled with judicious utilization of hospital resources.
由于胆石症相关性胰腺炎的自然病程具有复发倾向，因此必须针对胆道疾病进行手术治疗。但手术的恰当时机仍存在争议。自诊断胆石症相关性胰腺炎后，78例患者接受了早期手术治疗。其中18例患者既往有非酒精性胰腺炎发作史。依据兰森预后指标，52例患者为轻症胰腺炎，26例为重症胰腺炎。68例患者（87%）在入院后72小时内接受了手术，10例患者（13%）在5天内接受了手术。所有患者均接受了胆囊切除术及术中胆管造影。56例（72%）术中胆管造影呈阳性，42例患者（75%）经胆总管探查发现胆总管结石。无死亡病例，4例患者出现6种并发症，包括轻度持续性胰腺炎（2例）、伤口感染（1例）、尿路感染（1例）、心律失常（1例）及需要永久起搏器治疗的心脏传导阻滞（1例）。平均住院时间为10.4天。所有患者出院前行T管胆管造影均正常，且无胰腺炎复发情况。推荐对胆石症相关性胰腺炎尽早进行确定性手术，该手术可在合理利用医院资源的同时，将发病率和死亡率降至最低。
