合并胆囊结石急性胰腺炎病因辨析

Etiological analysis of acute pancreatitis combined with gallbladder stones

急性胰腺炎的常见病因有三大类:胆源性、高脂血症性和酒精性。临床上胆源性胰腺炎最常见。但是,合并胆囊结石的胰腺炎并非都由胆囊结石引起,任何导致胆胰管梗阻如胆道结石尤其微小结石、胆胰管解剖和功能异常甚至肿瘤等,均可成为胆源性胰腺炎的病因;另外,急性胰腺炎有时为单一病因,有时可能为多种因素叠加。病因分析不当容易引起治疗选择不当。对合并胆囊结石的胰腺炎实施胆囊切除术虽有共识,但有约1/3的胰腺炎病人胆囊切除术后仍可能复发,所以术前应尽可能排除胆囊结石以外的病因以降低复发率。随着标准化诊断技术的进步,不少合并胆囊结石的胰腺炎病人可检出一些其他的胰腺炎相关病因,目前至少在复发性以及特发性胰腺炎中,强调附加诊断措施的重要性,以确定由此获得的额外信息是否有助于胆囊切除术对预防胰腺炎复发的有效性,避免胆囊切除成为因其他病因导致胰腺炎复发的"替罪羊"。

There are three common causes of acute pancreatitis:bile origin,hyperlipidemia and alcoholism.Bilesource pancreatitis is the most common cause of acute pancreatitis.But on the one hand,the combined gallbladder stones of pancreatitis is not all gallbladder-sourced pancreatitis,gallbladder stones are not the cause of gallbladder-sourced pancreatitis,any cause of gallbladder tube obstruction such as gallbladder stones especially small stones;On the other hand,the onset of acute pancreatitis is sometimes a single cause,and may sometimes be superimposed by a variety of factors,such as gallbladder stones and alcohol consumption,overeating and hyperlipidemia.Improper analysis of the cause can easily lead to improper choice of treatment.Although there is consensus on the implementation of gallbladder excision for combined gallbladder stones,but about 1/3 of patients with gallbladder excision may still relapse,so before the implementation of gallbladder excision,the cause of gallbladder stones should be ruled out as far as possible,in order to reduce the recurrence rate after surgery.With standardized diagnostic methods and technological progress,many patients with pancreatitis combined with gallbladder stones can detect some other pancreatitis-related causes,at least in the recurrence and idrenapathic pancreatitis,emphasizing the importance of additional diagnostic measures,to determine whether the resulting additional information to help gallbladder excision to prevent the recurrence of pancreatitis effectiveness,to avoid gallbladder removal as a scapegoat for the recurrence of pancreatitis caused by other causes.