Kelly T R, Swaney P E
Surgery. 1982 Oct;92(4):571-5.
Over a 16-year period from 1965 to 1981, 35 patients who had undergone previous operation for gallstone pancreatitis were treated by us because of retained or recurrent common bile duct stones. The recurrence rate of gallstone pancreatitis in this study, after "the first time around," was 92%. The interval between the initial operation and the recurrent attack of gallstone pancreatitis ranged from 1 month to 30 years. The mean interval was 2 years for patients with retained stones and 12 years for patients with recurrent stones. There were stones present in 83% of the common bile ducts, 23% of which were impacted at the ampulla of Vater. Thirty-seven percent of the patients passed stones in the stool measuring up to 8 mm in size. Of the patients who had early operation, 66% had impacted ampullary stones, but only 18% of patients who underwent delayed surgery had such stones. The recurrence of gallstone pancreatitis, "the second time around," was only 2%. The data attest to the facts that (1) the natural history of a retained or recurrent common bile duct stone in a patient previously operated on for gallstone pancreatitis is recurrence of the disease, and (2) absolute stone clearance of the common bile duct the first time around will cure virtually all the patients. Further support for the "migratory theory" of gallstone pancreatitis is substantiated by this study.
在1965年至1981年的16年期间，我们对35例曾因胆石性胰腺炎接受过手术治疗的患者进行了治疗，原因是胆总管结石残留或复发。在本研究中，胆石性胰腺炎“首次发作”后的复发率为92%。初次手术与胆石性胰腺炎复发发作之间的间隔时间为1个月至30年。残留结石患者的平均间隔时间为2年，复发结石患者为12年。83%的胆总管存在结石，其中23%嵌顿于 Vater壶腹。37%的患者排出了大小达8毫米的粪便结石。早期手术的患者中，66%有壶腹嵌顿结石，但延迟手术的患者中只有18%有此类结石。胆石性胰腺炎“第二次发作”的复发率仅为2%。这些数据证明了以下事实：（1）既往因胆石性胰腺炎接受手术治疗的患者，胆总管结石残留或复发的自然病程是疾病复发；（2）首次手术时胆总管结石的绝对清除几乎可以治愈所有患者。本研究进一步支持了胆石性胰腺炎的“迁移理论”。
