DeIorio A V, Vitale G C, Reynolds M, Larson G M
Department of Surgery, University of Louisville, School of Medicine, KY 40292, USA.
Surg Endosc. 1995 Apr;9(4):392-6. doi: 10.1007/BF00187157.
Since January 1990, we have treated 113 patients for gallstone pancreatitis; 59 with laparoscopic cholecystectomy (LC), 50 with open cholecystectomy, and 4 with ERCP/sphincterotomy only. In the LC group, 47 had LC during the index admission and 12 underwent delayed LC. Fifty patients had open cholecystectomy, 47 during the index admission. ERCPs were performed in 43 of the 113 patients; CBD stones were identified in 19/43 (44%) and removed endoscopically in 18 (95%). The ERCP complication rate was 6.5%. In total, CBD stones were identified in 29/113 patients (26%). Patients who had imaging of the CBD within the first 4 days from onset of symptoms were more likely to have stones identified than were those patients who were studied after 5 days. Recurrent pancreatitis occurred in in five of 11 patients (45%) who had a > or = 30-day delay to definitive treatment. We conclude that LC can be safely performed in most patients during the index admission for gallstone pancreatitis. This policy should reduce the 30-50% risk of recurrent pancreatitis associated with a delayed operation. ERCP is a helpful adjunct for CBD stones.
自1990年1月以来，我们共治疗了113例胆石性胰腺炎患者；59例行腹腔镜胆囊切除术（LC），50例行开腹胆囊切除术，4例仅行内镜逆行胰胆管造影术（ERCP）/括约肌切开术。在LC组中，47例在首次住院期间行LC，12例接受了延期LC。50例行开腹胆囊切除术，其中47例在首次住院期间进行。113例患者中有43例行ERCP；19/43（44%）发现胆总管结石，18例（95%）经内镜取出。ERCP并发症发生率为6.5%。总共113例患者中有29例（26%）发现胆总管结石。症状发作后前4天内行胆总管成像的患者比5天后检查的患者更有可能发现结石。11例明确治疗延迟≥30天的患者中有5例（45%）发生复发性胰腺炎。我们得出结论，大多数胆石性胰腺炎患者在首次住院期间可安全地行LC。这一策略应能降低与手术延迟相关的30%-50%的复发性胰腺炎风险。ERCP对胆总管结石是一种有用的辅助手段。
