超声提示下124例胆石性胰腺炎临床分析  

Gallstone pancreatitis: analysis of 124 Cases with ultrasonography

作　　者：陈权海[1] 李清佩[1] 

机构地区：[1]上海第二医科大学附属新华医院普外科,200092

出　　处：《上海医学》1997年第9期504-506,共3页Shanghai Medical Journal

摘　　要：为探讨胆石性胰腺炎的合理治疗及合适的手术时机，本文作者在超声提示下分析了近五年来胆石性胰腺炎124例。手术113例，其中早期手术21例，死亡4例；延迟手术79例，择期手术13例，无死亡。非手术11例，死亡2例。同期，胆石症经手术治疗1044例（含胆石性胰腺炎113例），胆囊内含4颗以上≤5mm结石者，在胰腺炎组为86／113，非胰腺炎组为404／931，P＜0．01。胆囊管口径前组＞后组，P＜0．01；造影有胰管返流前组＞后组，P＜001，支持胆石性胰腺炎的发病机制，即在有乏特氏壶腹部的胆石症患者，由于胆囊内小结石经扩大的胆囊管移行至乏特氏壶腹暂时阻塞，引起胆汁或十二指肠液返流入胰管而致病。在治疗上，只要一经诊断，应行胆道手术。依据本文的临床和胰腺病理所见，认为应尽量避免早期手术，手术时机以入院后14～21天为宜。This paper deals with 124 cases of gallstone pancreatitis with ultrasonography during 5 years. Amongthe operative group, 113 patients were operated, in which 21 were performed in the early stage, 4 were dead. As for the79 delayed operation and 13 selective operations, no report of death is seen. And there were another 11 cases with con-servative therapy, 2 of them failed. At the same time, we performed 1044 patients of cholelithiasis. Those with 4 stonesand their diameters of less than 5mm, the ratio is 86/113 in the pancreatitis group. 404/931 in the nonpancreatitis group(P<0. 01). The openings of the cystic ducts is bigger in the first group, and the cholangiography indicated that tbere aremore pancreatic duct refux in the same group(i. e. the pancreatitis). (P<0. 01). Now it's clear that the cause of the gall-stone pancreatitis is quite in relevance with thq movement of small gallstones- They flow to the ampulla of vater by thepassage of cystic duct of dilatation, where it's tamporarily impacted, and the reflux of bile or deodenal juice to the pan-creatic duct lead to the disease. It's generally agreed that, in treatment, if diagnosis is made, biliary tract surgeryshould be manipulated. We believe that delayed (14~21 days) surgery of gallstone pancrentitis is the best.

关 键 词：胆石性胰腺炎 胆结石 胰腺炎 外科手术 

分 类 号：R657.51[医药卫生—外科学] R657.42[医药卫生—临床医学]