读书报告(修改4).ppt

 Acute gallstone pancreatitisTiming of laparoscopic cholecystectomy in mild and severe disease Rover Xu Background Gallstones and alcohol represent the most common etiologic factors in acute pancreatitis, accounting for 70% to 95% of all patients with this disease. The causative pathophysiologic factor of biliary acute pancreatitis is a distal common channel of the biliary and pancreatic ducts, which can be found in up to 80% of gallstone-related acute pancreatitis. The removal of the gallbladder was recommended during the same hospital stay because the recurrence rate of acute pancreatitis has been shown to be 29% to 63% if the patient is discharged from the hospital without additional treatment. The objective of this prospective study was to evaluate the role of laparoscopic cholecystectomy in biliary acute pancreatitis with reference to its feasibility and efficacy in mild and severe disease. Materials and methods A total of 77 patients with biliary acute pancreatitis were admitted between November 1993 and July 1998 (37 men and 40 women; mean age, 63 years; median Apache II score, 13.3) and staged by contrast-enhanced computed tomography findings as having edematous or necrotizing disease. Patients with biliary acute pancreatitis were treated according to the algorithm shown in Fig. 1. Fig. 1. Prospective algorithm in biliary acute pancreatitis. They were examined by an ERCP as early as possible after hospitalization. The severity of the disease in all patients was assessed by contrast- enhanced CT findings to stage the patients as having edematous (clinically mild) or necrotizing (severe) acute pancreatitis. In mild acute pancreatitis, an elective laparoscopic approach for the removal of the stone-filled gallbladder after subsidence of the acute symptoms was the first surgical option. Patients with necrotizing acute pancreatitis and development of sepsis underwent fine-needle as