Coppa G F, LeFleur R, Ranson J H
Ann Surg. 1981 Apr;193(4):393-8. doi: 10.1097/00000658-198104000-00001.
In patients with suspected severe acute pancreatitis and known or suspected cholelithiasis, it may be extremely difficult to exclude the diagnosis of gangrenous cholecystitis or obstructive cholangitis by nonoperative means. Since early intra-abdominal surgery has, in our experience, led to markedly increased morbidity in patients with gallstone pancreatitis, non-operative visualization of the biliary tree by percutaneous transhepatic Chiba-needle cholangiography (PTCNC) has been evaluated in 14 patients with suspected acute pancreatitis in whom life-threatening acute biliary disease could not be excluded by other nonoperative means. The final diagnosis was acute pancreatitis in nine patients (Group A) (mean serum amylase 3242 SU%) and acute biliary disease with hyperamylasemia in five patients (Group B) (mean serum amylase 2084 SU%). PTCNC made visualization of the biliary system possible in all patients and excluded the diagnosis of cystic duct or common duct obstruction in each case. Following PTCNC, potentially hazardous early laparotomy was avoided in eight of nine Group A patients. Biliary surgery was undertaken on day 3 to 13 in four Group B patients. When early laparotomy may be needed to evaluate or treat possible life-threatening acute biliary disease but is considered undesirable because of possible acute pancreatitis. PTCNC appears to be a safe and effective nonoperative method of obtaining precise anatomical delineation of the biliary tree.
对于疑似重症急性胰腺炎且已知或疑似患有胆石症的患者，通过非手术手段极难排除坏疽性胆囊炎或梗阻性胆管炎的诊断。根据我们的经验，早期腹部手术会显著增加胆石性胰腺炎患者的发病率，因此，我们对14例疑似急性胰腺炎且无法通过其他非手术手段排除危及生命的急性胆道疾病的患者进行了经皮肝穿刺千叶针胆管造影术（PTCNC）以对胆道系统进行非手术可视化评估。最终诊断结果为9例患者患有急性胰腺炎（A组）（血清淀粉酶平均为3242苏氏单位%），5例患者患有伴有高淀粉酶血症的急性胆道疾病（B组）（血清淀粉酶平均为2084苏氏单位%）。PTCNC使所有患者的胆道系统可视化，并排除了每例患者的胆囊管或胆总管梗阻诊断。在PTCNC之后，A组9例患者中有8例避免了有潜在危险的早期剖腹手术。B组4例患者在第3天至第13天进行了胆道手术。当可能需要早期剖腹手术来评估或治疗可能危及生命的急性胆道疾病，但由于可能存在急性胰腺炎而被认为不可取时，PTCNC似乎是一种安全有效的非手术方法，可用于精确显示胆道系统的解剖结构。
