Lecture onGallstone Associated Acute Pancreatitis

诊诊断断 全面

要有重点 有判断 有思路（各判断之间的联系）

具体 分类中所属位置 具体但要求足够的可信度 , 依据

动态 History, present, development

对策 Feedback

全 面 具 体

治治疗疗

DiagnosticsDiagnostics

DiagnosisDiagnosis Pancreatitis acute Biliary or gallstone associated Severe, I,II; Fulminant

Gallstone In Gallbladder: pacted ？ Strangulated? perforated ？ In CBD: Pacted? changitis ？ AOSC?

Metabolism 高渗，酮症，低血糖；电解质；… …

General condition

Complete

TreatmentTreatment

Diagnosis about AGPDiagnosis about AGPco

ncre

te

55 ％％HyperlipidemiaHyperlipidemia

2525 ％％AlcoholAlcohol

55 ％％OthersOthers

6565 ％％ GallstoneGallstone

Etiology of APEtiology of AP

Treatment Strategy for critical Patients, SAP II , AOSC

对因治疗 梗阻，感染灶

全身状态的评估与维护 氧供，氧输送；循环；糖代谢 脏器功能：心、肺、肝、肾、脑

手术的时机 选择与创造

Effective, but higher risks morbidity Mortality

op within 48h 83 ％ 18 ％op after 48h 48 ％ 12 ％

Strategy Discriminate those with obstruction and Cholangitis Endoscopy delayed operation

The role of emergency operation

Role of ERCP & EST During Severe Attack

Three trial / randomized and control Neoptolemos JP ； Fan ST

regardless of presence of obstructive jaundice and / or cholangitis

Folsch UR restricted to the patients with obstructive jaundice

and / or cholangitis References ： Neoptolemos JP, 6 papers

Ameliorate symptoms and progression

Operation to prevent the relapseOperation to prevent the relapse

Recommendation Cholecystectomy should be performed to avoid the

recurrence of Gallstone associated pancreatitis.

Evidence Recurrence in 29 ％ ~63 ％ cases if

Recommendation In mild cases, Cholecystectomy should be

performed as soon as the patients has recovered, and ideally during the same hospital admission.

In severe cases, Cholecystectomy should be delayed until sufficient resolution of the inflammatory response and clinical recovery.

EST to Prevent Further AttackEST to Prevent Further Attack

建议 : 对全身条件不适宜手术的病人，为降低胆石性胰腺炎复发的危险， EST 是胆囊切除术的替代措施。然而，理论上有导致无菌性胰腺坏死感染的危险（ B 级）

依据： EST in 5 series with a total of 109 cases: median follow-

up time 22~39 months, only 1 仅 1 例（ 0.9% ）复发 文献： Davidson BR 等 5 篇

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