Hammarström L E, Andersson R, Stridbeck H, Ihse I
Department of Surgery, University of Lund, S-221 851 Lund, Sweden.
World J Surg. 1999 Jan;23(1):12-7. doi: 10.1007/s002689900558.
The objective of this study was to study the influence on patients' features and the effect on early outcome of the presence of bile duct stones and endoscopic sphincterotomy (EST), respectively, in the presence of edematous gallstone pancreatitis (GSP). It was a retrospective review of a patient series from 1981 through 1992 at a university teaching hospital. Altogether 96 patients aged 42 to 93 years (median 74 years) with edematous GSP were investigated by endoscopic retrograde cholangiography (ERC) in our department, 75 of whom underwent ERC at first admission. A total of 49 patients (group 1) had common bile duct (CBD) stones, and in 47 (group 2) no CBD stones were found. All patients in group 1 and 15 in group 2 underwent EST; 57 of the 75 patients had EST at first admission. The main outcome measures were pancreas-related complications and the length of the hospital stay. The early major complication and stone clearance rates of the EST procedure were 3.2% and 96%, respectively. Duration of symptoms prior to ERC was similar in groups 1 and 2 (median 5 and 8 days, respectively). Serum amylase activity was higher in group 2 patients than in group 1 patients [21-258 (median 75) microkat/L vs. 10-328 (median 48) microkat/L (p = 0.01)], but the length of hospital stay was similar: [4-39 (median 11) days vs. 4-19 (median 9) days (p = 0.05)]. Cholangitis at acute admission was more common in group 1 than in group 2 patients (31% vs. 7%; p = 0. 02), whereas a history of pancreatitis was noted more often in group 2 patients (49% vs. 8%; p< 0.001). ERC was done 1 to 18 days (median 2 days) and 1-16 days (median 5 days) (p = 0.02) after admission in groups 1 and 2 respectively, because of the more frequent cholangitis symptoms in group 1. It was concluded that the history and features at admission differed between patients with and without CBD stones at ERC done during an attack of GSP. Early EST had no influence on outcome or hospitalization. This study does not support routine EST in conjunction with mild GSP.
本研究的目的是分别探讨在水肿型胆石性胰腺炎（GSP）患者中，胆管结石的存在及内镜括约肌切开术（EST）对患者特征的影响以及对早期预后的作用。这是一项对1981年至1992年在一所大学教学医院的患者系列进行的回顾性研究。我们科室共对96例年龄在42至93岁（中位年龄74岁）的水肿型GSP患者进行了内镜逆行胆管造影（ERC）检查，其中75例在首次入院时接受了ERC。共有49例患者（第1组）存在胆总管（CBD）结石，47例（第2组）未发现CBD结石。第1组的所有患者以及第2组的15例患者接受了EST；75例患者中有57例在首次入院时接受了EST。主要观察指标为胰腺相关并发症和住院时间。EST手术的早期主要并发症发生率和结石清除率分别为3.2%和96%。ERC检查前的症状持续时间在第1组和第2组中相似（分别为中位5天和8天）。第2组患者的血清淀粉酶活性高于第1组患者[21 - 258（中位75）微卡/升 vs. 10 - 328（中位48）微卡/升（p = 0.01）]，但住院时间相似：[4 - 39（中位11）天 vs. 4 - 19（中位9）天（p = 0.05）]。急性入院时胆管炎在第1组患者中比第2组更常见（31% vs. 7%；p = 0.02），而第2组患者中胰腺炎病史更为常见（49% vs. 8%；p < 0.001）。由于第1组胆管炎症状更频繁，第1组和第2组分别在入院后1至18天（中位2天）和1至16天（中位5天）进行了ERC（p = 0.02）。得出的结论是，在GSP发作期间进行ERC时，有和没有CBD结石的患者在入院时的病史和特征有所不同。早期EST对预后或住院情况没有影响。本研究不支持在轻度GSP患者中常规进行EST。
