胆源性胰腺炎的胆道探查及其定义

Bile duct exploration for patients with and biliary pancreatitis discussion of the concept

目的 :探讨胆源性胰腺炎胆道探查的必要性。方法 :总结我院近十年 37例胆源性胰腺炎的胆道探查情况 ,其中 2 8例直接切开胆总管探查 ,9例用胆囊切除后经胆囊管残端插管造影及扪诊的方法探查。结果 :术中探查及术后T管造影示无结石为 33例 ,占 89.2 % (33/ 37) ;有结石为 4例 ,占 10 .8% (4/ 37)。其中3例术前发现有胆总管 (CBD)结石 ,其余 34例诊断为“胆源性胰腺炎” ,而术前影像学诊断无胆总管结石 ,做胆总管探查 ,仅有一例有结石。结论 :应当正确定义“胆源性胰腺炎” ,胰腺炎发生时应严格限制作胆道探查。

Objective:To discuss the necessity of common bile duct exploration for biliary pancreatitis.Methods:37 cases of common bile duct exploration for biliary pancreatitis from 1991 till 1999 were analyzed. 28 cases were explored by choledochostomy during operation, and 9 cases of cholangiography by gallbadder duct catheterization after cholecystectomy.Results:There were 33 cases of billiary stone negative in total 37 cases(89.2%). And 4 cases of billiary stone positive(10.8%),of which 3 were confirmed CBD stone pre operation. In other 34 cases of common bile duct exploration stone was found in only one case,with very low positive rate of CBD stone.Conclusion:In common bile duct exploration for billiary pancreatitis, the 'billiary' pancreatitis widely used in clinic should be strictly defined and the indications should be strictly limited.