Uomo G, Slavin J
Pancreas Unit, Cardarelli Hospital, Napoli, Italy.
Ital J Gastroenterol Hepatol. 1998 Oct;30(5):557-61.
Pathogenetic factors of acute biliary pancreatitis include persistent or transient, absolute or relative, obstruction of Vater's ampulla or the main pancreatic duct and reflux of bile into the pancreatic ducts or of pancreatic juice into the bile ducts. There is an increasing incidence of persisting common bile duct stones in the more severe forms of acute biliary pancreatitis, in patients who die, and in patients with pancreatic necrosis. All these findings provide a rational basis for the use of early biliary decompression in patients with acute biliary pancreatitis. Endoscopic sphincterotomy offers a cost-effective and safe alternative to surgical biliary decompression with an overall morbidity rate of 8% and mortality rate of 2.4%. Randomized clinical trials showed that endoscopic sphincterotomy is useful in patients with predicted severe attack of acute biliary pancreatitis and is clearly indicated in all patients who are jaundiced or who have associated cholangitis. In addition, the procedure is valid in preventing recurrent attack of acute biliary pancreatitis in high risk elderly patients with gallstones, unfit for any kind of cholecystectomy.
急性胆源性胰腺炎的发病因素包括持续性或短暂性、绝对性或相对性的 Vater 壶腹或主胰管梗阻，以及胆汁反流至胰管或胰液反流至胆管。在急性胆源性胰腺炎的更严重形式、死亡患者以及胰腺坏死患者中，胆总管结石持续存在的发生率不断增加。所有这些发现为急性胆源性胰腺炎患者早期胆道减压的应用提供了合理依据。内镜下括约肌切开术是一种经济有效且安全的手术胆道减压替代方法，总体发病率为 8%，死亡率为 2.4%。随机临床试验表明，内镜下括约肌切开术对预测为急性胆源性胰腺炎严重发作的患者有用，并且在所有黄疸患者或伴有胆管炎的患者中明确适用。此外，该手术对于预防患有胆结石、不适合任何类型胆囊切除术的高危老年患者急性胆源性胰腺炎的复发有效。
