Gadacz T R, Lillemoe K, Zinner M, Merrill W
Surgery. 1983 Feb;93(2):235-42.
Five cases that illustrate the spectrum of biliary complications of pancreatitis and pancreatic pseudocyst are discussed. Obstructive jaundice, hemobilia, and bilious ascites were the major problems in these five patients. Sonography, transhepatic cholangiogram, endoscopic retrograde cholangiopancreatography, operative cholangiography, and arteriography are important in establishing the diagnosis and planning the treatment. Three patients had biliary obstruction caused by chronic pancreatitis, a pancreatic pseudocyst, or both. Two patients had a fistula between the common duct and the pseudocyst. Simple decompression of the pseudocyst was curative for only one patient. Three patients required decompression of the biliary tract, which emphasizes the need for intraoperative cholangiography. One patient required a Whipple operation to control hemorrhage but died in the immediate postoperative period. The operative findings determine the specific procedures for biliary tract decompression and pseudocyst drainage.
讨论了5例说明胰腺炎和胰腺假性囊肿胆道并发症范围的病例。梗阻性黄疸、胆道出血和胆汁性腹水是这5例患者的主要问题。超声检查、经肝胆管造影、内镜逆行胰胆管造影、手术胆管造影和动脉造影对确立诊断和制定治疗方案很重要。3例患者因慢性胰腺炎、胰腺假性囊肿或两者兼有而出现胆道梗阻。2例患者在胆总管和假性囊肿之间存在瘘管。单纯的假性囊肿减压仅对1例患者有效。3例患者需要胆道减压，这突出了术中胆管造影的必要性。1例患者需要进行惠普尔手术以控制出血，但在术后不久死亡。手术所见决定了胆道减压和假性囊肿引流的具体操作。
