急性胆源性胰腺炎行胆囊切除术时机的选择
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摘要
胆石症是引起急性胰腺炎最常见的原因,在我国占全部胰腺炎的50%。大约15%～20%的病人起病急且较重,发病率和病死率都很高。胆囊切除术是预防急性胆源性胰腺炎复发的有效措施,已经成为急性胆源性胰腺炎常规治疗中的一部分,但对于急性胆源性胰腺炎发作后行胆囊切除术的时机仍然存在争议。该文通过复习相关文献,从轻型急性胆源性胰腺炎病人与中重型急性胆源性胰腺炎病人的差异来讨论行胆囊切除术的最佳时机。
Cholelithiasis is the most common cause of acute pancreatitis, accounting for 50% of all pancreatitis in China. About 15% to 20% of patients have an acute and severe onset with high morbidity and mortality. Cholecystectomy is an effective measure to prevent the recurrence of acute biliary pancreatitis and has become a part of routine treatment of acute biliary pancreatitis, but the timing of cholecystectomy after the onset of acute biliary pancreatitis remains controversial. In this paper, we reviewed the literature and discuss the optimal timing of cholecystectomy from the difference between mild acute biliary pancreatitis patients and moderate and severe acute biliary pancreatitis patients.
Cholelithiasis is the most common cause of acute pancreatitis, accounting for 50% of all pancreatitis in China. About 15% to 20% of patients have an acute and severe onset with high morbidity and mortality. Cholecystectomy is an effective measure to prevent the recurrence of acute biliary pancreatitis and has become a part of routine treatment of acute biliary pancreatitis, but the timing of cholecystectomy after the onset of acute biliary pancreatitis remains controversial. In this paper, we reviewed the literature and discuss the optimal timing of cholecystectomy from the difference between mild acute biliary pancreatitis patients and moderate and severe acute biliary pancreatitis patients.
引文
[1] Tse F,Yuan Y.Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis[J].Cochrane Database Syst Rev,2012,5:CD009779.DOI:10.1002/14651858.CD009779.pub2.
[2] Banks PA,Bollen TL,Dervenis C,et al.Classification of acute pancreatitis——2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62(1):102-111.DOI:10.1136/gutjnl-2012-302779.
[3] Melman L,Azar R,Beddow K,et al.Primary and overall success rates for clinical outcomes after laparoscopic,endoscopic,and open pancreatic cystgastrostomy for pancreatic pseudocysts[J].Surg Endosc,2009,23(2):267-271.DOI:10.1007/s00464-008-0196-2.
[4] Johnson CD,Abu-Hilal M.Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis[J].Gut 2004,53(9):1340-1344.DOI:10.1136/gut.2004.039883.
[5] Tenner S,Baillie J,DeWitt J,et al.American College of Gastroenterology guideline:management of acute pancreatitis[J].Am J Gastroenterol,2013,108(9):1400-1415;1416.DOI:10.1038/ajg.2013.218.
[6] Mustafa A,Begaj I,Deakin M,et al.Long-term effectiveness of cholecystectomy and endoscopic sphincterotomy in the management of gallstone pancreatitis.Surg Endosc,2014,28(1):127-133.DOI:10.1007/00464-013-3138-6.
[7] Sanjay P,Yeeting S,Whigham C,et al.Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP)[J].Surg Endosc,2008,22(8):1832-1837.DOI:10.1007/s00464-007-9710-1.
[8] van Geenen EJ,van Santvoort HC,Besselink MG,et al.Lack of consensus on the role of endoscopic retrograde cholangiography in acute biliary pancreatitis in published meta-analyses and guidelines:a systematic review[J].Pancreas,2013,42(5):774-780.DOI:10.1097/MPA.0b013e318287d208.
[9] ASGE Standards of Practice Committee,Muthusamy VR,Chandrasekhara V,et al.The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections[J].Gastrointest Endosc,2016,83(3):481-488.DOI:10.1016/j.gie.2015.11.027.
[10] Shir L,Razman J,Kin F,et al.Outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis:A randomized prospective study[J].Asian J Surg,2018,41(1):47-54.DOI:10.1016/j.asjsur.2016.07.010
[11] Aksoy F,Demiral G,Ekinci ?.Can the timing of laparoscopic cholecystectomy after biliary pancreatitis change the conversion rate to open surgery?[J].Asian J Surg,2018,41(4):307-312.DOI:10.1016/j.asjsur.2017.02.001.
[12] Taylor EW,Wong C.The optimal timing of laparoscopic cholescystectomy in mild gallstone pancreatitis[J].Am Surg,2004,70(11):971-975.DOI:10.1111/j.1600-6143.2004.00538.x.
[13] 廖作富,李军,谢江,等.腹腔镜胆囊切除术治疗胆源性胰腺炎的时机分析[J].江苏大学学报,2017,27(6):S33-S35.DOI:10.13312 /j.issn.1671-7783.y170042.
[14] Wilson CT,de Moya MA.Cholecystectomy for acute gallstone pancreatitis:early vs delayed approach[J].Scand J Surg,2010,99(2):81-85.DOI:10.1177/145749691009900207.
[15] Bougard M,Barbier L,Godart B,et al.Management of biliary acute pancreatitis[J].J Visc Surg,2019,156(2):113-125.DOI:10.1016/j.jviscsurg.2018.08.002.
[16] Sanjay P,Yeeting S,Whigham C,et al.Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis(GSP)[J].Surg Endosc,2008,22(8):1832-1837.DOI:10.1007/s00464-007-9710-1.
[17] Johnstone M,Marriott P,Royle TJ,et al.The impact of timing of cholecystectomy following gallstone pancreatitis[J].Surgeon,2014,12(3):134-140.DOI:10.1016/j.surge.2013.07.006.
[18] Hwang SS,Li BH,Haigh PI.Gallstone pancreatitis without cholecystectomy[J].JAMA Surg,2013,148(9):867-872.DOI:10.1001/jamasurg.2013.3033.
[19] Forsmark CE,Baillie J.AGA Institute technical review on acute pancreatitis[J].Gastroenterology,2007,132(5):2022-2044.DOI:10.1053/j.gastro.2007.03.065.
[20] Nebiker CA,Frey DM,Hamel CT,et al.Early versus delayed cholecystectomy in patients with biliary acute pancreatitis[J].Surgery,2009,145(3):260-264.DOI:10.1016/j.surg.2008.10.012.
[21] Lankisch PG,Weber-Dany B,Maisonneuve P,et al.Pancreatic pseudocysts:prognostic factors for their development and their spontaneous resolution in the setting of acute pancreatitis[J].Pancreatology,2012,12(2):85-90.DOI:10.1016/j.pan.2012.02.007.
[22] Jacobson BC,Baron TH,Adler DG,et al.ASGE guideline:The role of endoscopy in the diagnosis and the management of cystic lesions and inflammatory fluid collections of the pancreas[J].Gastrointest Endosc,2005,61(3):363-370.DOI:10.1016/S0016-5107/(04)02779-8.
[23] Pezzilli R,Zerbi A,Campra D,et al.Consensus guidelines on severe acute pancreatitis[J].Dig Liver Dis,2015,47(7):532-543.DOI:10.1016/j.dld.2015.03.022.
[24] Working Group IAP/APA Acute Pancreatitis Guidelines.IAP/APA evidence-based guidelines for the management of acute pancreatitis.Pancreatology[J].2013,13 (4 Suppl 2):e1-e15.DOI:10.1016/J.PEN.2013.07.063.
[25] Ito K,Ito H,Whang EE.Timing of cholecystectomy for biliary pancreatitis:do the data support current guidelines?[J].J Gastrointest Surg,2008,12(12):2164-2170.DOI:10.1007/s11605-008-0603-y.
[26] Nealon WH,Walser E.Main pancreatic ductal anatomy can direct choice of modality for treating pancreatic pseudocysts (surgery versus percutaneous drainage)[J].Ann Surg,2002,235(6):751-758.DOI:10.1097/00000658-200206000-00001.
[27] Vilmann AS,Menachery J,Tang SJ,et al.Endosonography guided management of pancreatic fluid collections[J].World J Gastroenterol,2015,21(41):11842-11853.DOI:10.3748/wjg.v21.i41.11842.
[28] Johnstone M,Marriott P,Royle TJ,et al.The impact of timing of cholecystectomy following gallstone pancreatitis[J].Surgeon,2014,12(3):134-140.DOI:10.1016/j.surge.2013.07.006.
[29] Andrén-Sandberg A,Dervenis C.Pancreatic pseudocysts in the 21st century.Part Ⅰ:classification,pathophysiology,anatomic considerations and treatment[J].JOP,2004,5(1):8-24.DOI:10.1016/0002-9610(79)90024-2.
[30] Kaw M,Al-Antably Y,Kaw P.Management of gallstone pancreatitis:cholecystectomy or ERCP and endoscopic sphincterotomy[J].Gastrointest Endosc,2002,56(1):61-65.DOI:10.1067/mge.2002.12544.
[31] Guenther L,Hardt PD,Collet P.Review of current therapy of pancreatic pseudocysts[J].Z Gastroenterol,2015,53(2):125-135.DOI:10.1055/s-0034-1385713.
[32] Nguyen GC,Rosenberg M,Chong RY,et al.Early cholecystectomy and ERCP are associated with reduced readmissions for acute biliary pancreatitis:a nationwide,population-based study[J].Gastrointest Endosc,2012,75(1):47-55.DOI:10.1016/j.gie.2011.08.028.
[33] Baal MC,Besselink MG,Bakker OJ,et al.Timing of cholecystectomy after mild biliary pancreatitis:a systematic review[J].Ann Surg,2012,255(5):860-866.DOI:10.1097/SLA.0b013e3182507646.
[34] Nealon WH,Bawduniak J,Walser EM.Appropriate timing of cholecystectomy in patients who present with moderate to severe gallstone-associated acute pancreatitis with peripancreatic fluid collections[J].Ann Surg,2004,239(6):741-751.DOI:10.1097/01.sia.0000128688.97556.94.
[35] Heider TR,Brown A,Grimm IS,et al.Endoscopic sphincterotomy permits interval laparoscopic cholecystectomy in patients with moderately severe gallstone pancreatitis[J].J Gastrointest Surg,2006,10(1):1-5.DOI:10.1016/j.gassur.2005.10.009.
[36] Sanjay P,Yeeting S,Whigham C,et al.Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP)[J].Surg Endosc,2008,22(8):1832-1837.DOI:10.1007/s00464-007-9710-1.
[37] Palanivelu C,Senthilkumar K,Madhankumar MV,et al.Management of pancreatic pseudocyst in the era of laparoscopic surgery——experience from a tertiary centre[J].Surg Endosc,2007,21(12):2262-2267.DOI:10.1007/s00464-007-9365-y.
[38] Varadarajulu S,Bang JY,Sutton BS,et al.Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial[J].Gastroenterology,2013,145(3):583-590.e1.DOI:101016/j.gie.2011.03.1122.
[39] Ramia JM,Fabregat J,Pérez-Miranda M,et al.Disconnected panreatic duct syndrome[J].Cir Esp,2014,92(1):4-10.DOI:10.1016/j.ciresp.2013.02.024.
[40] 宋兴超,吴磊,路要武.急性胆源性胰腺炎患者行腹腔镜胆囊切除手术时机选择探讨[J].中国普通外科杂志,2018,27(3):349-354.DOI:10.3978/j.issn.1005-6947.
[41] Yang DJ,Lu HM,Guo Q,et al.Timing of Laparoscopic Cholecystectomy After Mild Biliary Pancreatitis:A Systematic Review and Meta-Analysis[J].J Laparoendosc Adv Surg Tech A,2018,28 (4):379-388.DOI:10.1089/lap.2017.0527.
[42] DiMaio CJ.Management of complications of acute pancreatitis[J].J Curr Opin Gastroenterol,2018,34(5):336-342.DOI:10.1097/MOG.0000000000000462.
[43] Schachter P,Peleg T,Cohen O.Interval laparoscopic cholecystectomy in the management of acute biliary pancreatitis[J].HPB Surg,2000,11(5):319-323.DOI:10.1155/2000/40290.
[2] Banks PA,Bollen TL,Dervenis C,et al.Classification of acute pancreatitis——2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62(1):102-111.DOI:10.1136/gutjnl-2012-302779.
[3] Melman L,Azar R,Beddow K,et al.Primary and overall success rates for clinical outcomes after laparoscopic,endoscopic,and open pancreatic cystgastrostomy for pancreatic pseudocysts[J].Surg Endosc,2009,23(2):267-271.DOI:10.1007/s00464-008-0196-2.
[4] Johnson CD,Abu-Hilal M.Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis[J].Gut 2004,53(9):1340-1344.DOI:10.1136/gut.2004.039883.
[5] Tenner S,Baillie J,DeWitt J,et al.American College of Gastroenterology guideline:management of acute pancreatitis[J].Am J Gastroenterol,2013,108(9):1400-1415;1416.DOI:10.1038/ajg.2013.218.
[6] Mustafa A,Begaj I,Deakin M,et al.Long-term effectiveness of cholecystectomy and endoscopic sphincterotomy in the management of gallstone pancreatitis.Surg Endosc,2014,28(1):127-133.DOI:10.1007/00464-013-3138-6.
[7] Sanjay P,Yeeting S,Whigham C,et al.Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP)[J].Surg Endosc,2008,22(8):1832-1837.DOI:10.1007/s00464-007-9710-1.
[8] van Geenen EJ,van Santvoort HC,Besselink MG,et al.Lack of consensus on the role of endoscopic retrograde cholangiography in acute biliary pancreatitis in published meta-analyses and guidelines:a systematic review[J].Pancreas,2013,42(5):774-780.DOI:10.1097/MPA.0b013e318287d208.
[9] ASGE Standards of Practice Committee,Muthusamy VR,Chandrasekhara V,et al.The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections[J].Gastrointest Endosc,2016,83(3):481-488.DOI:10.1016/j.gie.2015.11.027.
[10] Shir L,Razman J,Kin F,et al.Outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis:A randomized prospective study[J].Asian J Surg,2018,41(1):47-54.DOI:10.1016/j.asjsur.2016.07.010
[11] Aksoy F,Demiral G,Ekinci ?.Can the timing of laparoscopic cholecystectomy after biliary pancreatitis change the conversion rate to open surgery?[J].Asian J Surg,2018,41(4):307-312.DOI:10.1016/j.asjsur.2017.02.001.
[12] Taylor EW,Wong C.The optimal timing of laparoscopic cholescystectomy in mild gallstone pancreatitis[J].Am Surg,2004,70(11):971-975.DOI:10.1111/j.1600-6143.2004.00538.x.
[13] 廖作富,李军,谢江,等.腹腔镜胆囊切除术治疗胆源性胰腺炎的时机分析[J].江苏大学学报,2017,27(6):S33-S35.DOI:10.13312 /j.issn.1671-7783.y170042.
[14] Wilson CT,de Moya MA.Cholecystectomy for acute gallstone pancreatitis:early vs delayed approach[J].Scand J Surg,2010,99(2):81-85.DOI:10.1177/145749691009900207.
[15] Bougard M,Barbier L,Godart B,et al.Management of biliary acute pancreatitis[J].J Visc Surg,2019,156(2):113-125.DOI:10.1016/j.jviscsurg.2018.08.002.
[16] Sanjay P,Yeeting S,Whigham C,et al.Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis(GSP)[J].Surg Endosc,2008,22(8):1832-1837.DOI:10.1007/s00464-007-9710-1.
[17] Johnstone M,Marriott P,Royle TJ,et al.The impact of timing of cholecystectomy following gallstone pancreatitis[J].Surgeon,2014,12(3):134-140.DOI:10.1016/j.surge.2013.07.006.
[18] Hwang SS,Li BH,Haigh PI.Gallstone pancreatitis without cholecystectomy[J].JAMA Surg,2013,148(9):867-872.DOI:10.1001/jamasurg.2013.3033.
[19] Forsmark CE,Baillie J.AGA Institute technical review on acute pancreatitis[J].Gastroenterology,2007,132(5):2022-2044.DOI:10.1053/j.gastro.2007.03.065.
[20] Nebiker CA,Frey DM,Hamel CT,et al.Early versus delayed cholecystectomy in patients with biliary acute pancreatitis[J].Surgery,2009,145(3):260-264.DOI:10.1016/j.surg.2008.10.012.
[21] Lankisch PG,Weber-Dany B,Maisonneuve P,et al.Pancreatic pseudocysts:prognostic factors for their development and their spontaneous resolution in the setting of acute pancreatitis[J].Pancreatology,2012,12(2):85-90.DOI:10.1016/j.pan.2012.02.007.
[22] Jacobson BC,Baron TH,Adler DG,et al.ASGE guideline:The role of endoscopy in the diagnosis and the management of cystic lesions and inflammatory fluid collections of the pancreas[J].Gastrointest Endosc,2005,61(3):363-370.DOI:10.1016/S0016-5107/(04)02779-8.
[23] Pezzilli R,Zerbi A,Campra D,et al.Consensus guidelines on severe acute pancreatitis[J].Dig Liver Dis,2015,47(7):532-543.DOI:10.1016/j.dld.2015.03.022.
[24] Working Group IAP/APA Acute Pancreatitis Guidelines.IAP/APA evidence-based guidelines for the management of acute pancreatitis.Pancreatology[J].2013,13 (4 Suppl 2):e1-e15.DOI:10.1016/J.PEN.2013.07.063.
[25] Ito K,Ito H,Whang EE.Timing of cholecystectomy for biliary pancreatitis:do the data support current guidelines?[J].J Gastrointest Surg,2008,12(12):2164-2170.DOI:10.1007/s11605-008-0603-y.
[26] Nealon WH,Walser E.Main pancreatic ductal anatomy can direct choice of modality for treating pancreatic pseudocysts (surgery versus percutaneous drainage)[J].Ann Surg,2002,235(6):751-758.DOI:10.1097/00000658-200206000-00001.
[27] Vilmann AS,Menachery J,Tang SJ,et al.Endosonography guided management of pancreatic fluid collections[J].World J Gastroenterol,2015,21(41):11842-11853.DOI:10.3748/wjg.v21.i41.11842.
[28] Johnstone M,Marriott P,Royle TJ,et al.The impact of timing of cholecystectomy following gallstone pancreatitis[J].Surgeon,2014,12(3):134-140.DOI:10.1016/j.surge.2013.07.006.
[29] Andrén-Sandberg A,Dervenis C.Pancreatic pseudocysts in the 21st century.Part Ⅰ:classification,pathophysiology,anatomic considerations and treatment[J].JOP,2004,5(1):8-24.DOI:10.1016/0002-9610(79)90024-2.
[30] Kaw M,Al-Antably Y,Kaw P.Management of gallstone pancreatitis:cholecystectomy or ERCP and endoscopic sphincterotomy[J].Gastrointest Endosc,2002,56(1):61-65.DOI:10.1067/mge.2002.12544.
[31] Guenther L,Hardt PD,Collet P.Review of current therapy of pancreatic pseudocysts[J].Z Gastroenterol,2015,53(2):125-135.DOI:10.1055/s-0034-1385713.
[32] Nguyen GC,Rosenberg M,Chong RY,et al.Early cholecystectomy and ERCP are associated with reduced readmissions for acute biliary pancreatitis:a nationwide,population-based study[J].Gastrointest Endosc,2012,75(1):47-55.DOI:10.1016/j.gie.2011.08.028.
[33] Baal MC,Besselink MG,Bakker OJ,et al.Timing of cholecystectomy after mild biliary pancreatitis:a systematic review[J].Ann Surg,2012,255(5):860-866.DOI:10.1097/SLA.0b013e3182507646.
[34] Nealon WH,Bawduniak J,Walser EM.Appropriate timing of cholecystectomy in patients who present with moderate to severe gallstone-associated acute pancreatitis with peripancreatic fluid collections[J].Ann Surg,2004,239(6):741-751.DOI:10.1097/01.sia.0000128688.97556.94.
[35] Heider TR,Brown A,Grimm IS,et al.Endoscopic sphincterotomy permits interval laparoscopic cholecystectomy in patients with moderately severe gallstone pancreatitis[J].J Gastrointest Surg,2006,10(1):1-5.DOI:10.1016/j.gassur.2005.10.009.
[36] Sanjay P,Yeeting S,Whigham C,et al.Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP)[J].Surg Endosc,2008,22(8):1832-1837.DOI:10.1007/s00464-007-9710-1.
[37] Palanivelu C,Senthilkumar K,Madhankumar MV,et al.Management of pancreatic pseudocyst in the era of laparoscopic surgery——experience from a tertiary centre[J].Surg Endosc,2007,21(12):2262-2267.DOI:10.1007/s00464-007-9365-y.
[38] Varadarajulu S,Bang JY,Sutton BS,et al.Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial[J].Gastroenterology,2013,145(3):583-590.e1.DOI:101016/j.gie.2011.03.1122.
[39] Ramia JM,Fabregat J,Pérez-Miranda M,et al.Disconnected panreatic duct syndrome[J].Cir Esp,2014,92(1):4-10.DOI:10.1016/j.ciresp.2013.02.024.
[40] 宋兴超,吴磊,路要武.急性胆源性胰腺炎患者行腹腔镜胆囊切除手术时机选择探讨[J].中国普通外科杂志,2018,27(3):349-354.DOI:10.3978/j.issn.1005-6947.
[41] Yang DJ,Lu HM,Guo Q,et al.Timing of Laparoscopic Cholecystectomy After Mild Biliary Pancreatitis:A Systematic Review and Meta-Analysis[J].J Laparoendosc Adv Surg Tech A,2018,28 (4):379-388.DOI:10.1089/lap.2017.0527.
[42] DiMaio CJ.Management of complications of acute pancreatitis[J].J Curr Opin Gastroenterol,2018,34(5):336-342.DOI:10.1097/MOG.0000000000000462.
[43] Schachter P,Peleg T,Cohen O.Interval laparoscopic cholecystectomy in the management of acute biliary pancreatitis[J].HPB Surg,2000,11(5):319-323.DOI:10.1155/2000/40290.