Curran F T, Neoptolemos J P
Academic Department of Surgery, City Hospital, Birmingham.
Ann Ital Chir. 1995 Mar-Apr;66(2):197-202.
The development of acute pancreatitis occurs in 4-8% of patients with symptomatic gallstones. Individuals predisposed to acute pancreatitis tend to have small gallstones (with or without larger gallstones), a wide cystic duct and a common channel between the biliary and pancreatic ducts. The importance of this relationship is demonstrated by the ability of urgent endoscopic sphincterotomy (ES) to improve the outcome of a predicted severe attack and to virtually abolish recurrent attacks in patients who are unable to undergo cholecystectomy. Cholesterolosis is an established cause of acute pancreatitis, occurring in up to 29% of cases with cholesterolosis. Biliary crystals are an important marker of microlithiasis or a propensity to form further gallstones following their passage into the duodenum following an attack. A combination of ultrasonography and a serum liver transaminase of > 60 IU/I (< 48 hr o an attack) are necessary to provide optimum sensitivity and specificity for gallstones as a prompt for the use of ERCP and ES in severe cases. Biliary sludge as a cause of acute pancreatitis is not proven. 25-30% of patients will develop complications with a mortality of around 8%. Urgent diagnosis of gallstones and treatment by ES can result in substantial improvement in outcome.
在有症状的胆结石患者中，4% - 8%会发生急性胰腺炎。易患急性胰腺炎的个体往往有小胆结石（有或没有更大的结石）、胆囊管宽阔以及胆管和胰管之间存在共同通道。紧急内镜括约肌切开术（ES）能够改善预计的重症发作的结局，并实际上消除无法接受胆囊切除术的患者的复发发作，这证明了这种关系的重要性。胆固醇沉着症是急性胰腺炎的既定病因，在胆固醇沉着症病例中发生率高达29%。胆结晶是微结石症的重要标志物，或者是发作后进入十二指肠后形成更多胆结石倾向的重要标志物。超声检查和血清肝转氨酶> 60 IU/I（发作后< 48小时）相结合，对于胆结石作为重症病例中使用内镜逆行胰胆管造影（ERCP）和ES的提示，提供最佳的敏感性和特异性是必要的。胆泥作为急性胰腺炎的病因尚未得到证实。25% - 30%的患者会出现并发症，死亡率约为8%。胆结石的紧急诊断和ES治疗可使结局得到显著改善。
