急性胰腺炎患者的胆道手术：目的、适应证及时机
Operations upon the biliary tract in patients with acute pancreatitis: aims, indications and timing.
作者信息
Mayer A D, McMahon M J, Benson E A, Axon A T
出版信息
Ann R Coll Surg Engl. 1984 May;66(3):179-83.
Abstract
The management of gallstones in patients with acute pancreatitis (AP) is controversial. This paper reports an analysis of 171 attacks of AP associated with gallstones. Whilst awaiting elective cholecystectomy 56% of patients had further symptoms and 1 died. Non-urgent operations during the same admission as the pancreatitis (n = 34) resulted in 2 deaths and 7 septic complications, but prediction of complications may be possible. Urgent surgery (n = 5) was followed by 3 deaths. This study suggests that in most patients, cholecystectomy should be performed as soon as the patient is adequately fit. Urgent removal of an impacted ampullary stone (preferably by endoscopic papillotomy) may be required in a small minority if severe pancreatitis fails to respond to medical treatment, or if cholangitis supervenes .
摘要
急性胰腺炎（AP）患者胆结石的处理存在争议。本文报告了对171例与胆结石相关的AP发作病例的分析。在等待择期胆囊切除术期间，56%的患者出现了进一步症状，1例死亡。在与胰腺炎同一住院期间进行的非紧急手术（n = 34）导致2例死亡和7例感染性并发症，但并发症可能是可以预测的。紧急手术（n = 5）后有3例死亡。本研究表明，在大多数患者中，一旦患者身体状况足够适宜，就应尽快进行胆囊切除术。如果严重胰腺炎对药物治疗无反应，或发生胆管炎，少数情况下可能需要紧急取出嵌顿的壶腹结石（最好通过内镜乳头切开术）。
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