Optimal timing of laparoscopic cholecystectomy in mild acute gallstone pancreatitis
- Author:
- No author available
- Journal Title:
- 中华胰腺病杂志
- Issue:
- 5
- DOI:
- 10.3760/cma.j.issn.1674-1935.2016.05.008
- Key Word:
- 胰腺炎;体层摄影术,X线计算机;胆囊切除术,腹腔镜;Pancreatitis;Tomography,X-ray computed;Cholecystectomy,laparoscopic
Abstract： Objective To assess the optimal timing of laparoscopic cholecystectomy ( LC ) in mild acute gallstone pancreatitis ( mAGP) .Methods From May 1, 2012 to August 30, 2015, consecutive patients with mAGP were prospectively assessed.Each patient underwent abdominal computed tomography scan within 48 h after mAGP onset to assess the presence of peripancreatitc fluid collection, and Marshall score was used to assess if there was organ failure.Patients with neither peripancreatic fluid collection by CT ( classified as grade A, B or C based on the Balthazar CT grading system) nor organ failure by clinical data (Marshall score <2) were randomized according to simple randomization into early laparoscopic cholecystectomy ( ELC; LC performed within 7 days after a pancreatitis attack, without waiting for symptom resolution) or late laparoscopic cholecystectomy ( LLC; LC performed ≥7 days following an attack, with complete remission of AGP symptoms) group.The mean LC operation time, bleeding during LC, post-LC complications and lengths of hospital stay between the ELC group and LLC group were compered.Results The study enrolled 102 patients with mAGP.A total of 49 and 53 patients were assigned to ELC and LLC group, respectively.The mean LC operation time and lengths of hospital stay were significantly shorter in the ELC group than in the LLC group [(19.9 ±5.3) vs(31.1 ±8.4) min;(7.9 ±1.8) vs (16.8 ±5.3) d, P<0.05], while there were no significant difference on bleeding during LC and post-LC complications.Conclusions LC for patients with mAGP who had neither peripancreatic fluid collection nor organ failure within 7 days after the onset was safe and feasible.
- [1]李能平,陆仁达,周鸣清.急性胆源性胰腺炎复发的预防[J].2006,(1).
- [2]李能平,杨欣,顾永峰,等.急性胰周积液和胰腺坏死对急性胰腺炎预后的影响[J].2009,(2).
- [3]肖竣,陈海川,俞海波,等.胆囊结石伴急性胆源性胰腺炎的微创治疗[J].2014,(5).
- [4]J H, Ranson.The timing of biliary surgery in acute pancreatitis.[J].1979,189(5).
- [5]Marianne, Johnstone,Paul, Marriott,T James, Royle,etc.The impact of timing of cholecystectomy following gallstone pancreatitis.[J].2014,12(3).
- [6]Paul Georg Lankisch,Bettina Weber-Dany,Markus M. Lerch.Clinical perspectives in pancreatology: Compliance with acute pancreatitis guidelines in Germany[J].2005,5(6).
- [7]Yokoe, Masamichi,Takada, Tadahiro,Mayumi, Toshihiko,etc.Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015[J].2015,22(6).
- [8]E, Tang,S C, Stain,G, Tang,etc.Timing of laparoscopic surgery in gallstone pancreatitis.[J].1995,130(5).
- [9]van Santvoort HC,Schaapherder AF,Bollen TL,etc.Timing of cholecystectomy after mild biliary pancreatitis.[J].2011,98(10).
- [10]P. Tondelli,K. Stutz,F. Harder,etc.Acute gallstone pancreatitis: Best timing for biliary surgery[J].1982,69(12).
- [11]Court EL,Dash I,Monkhouse SJ.Two-week target for laparoscopic cholecystectomy following gallstone pancreatitis is achievable and cost neutral.[J].2009,96(7).
- [12]Stephanie S, Hwang,Bonnie H, Li,Philip I, Haigh.Gallstone pancreatitis without cholecystectomy.[J].2013,148(9).
- [13]Tenner,S.,Baillie,J.,Dewitt,J.,etc.American college of gastroenterology guideline: Management of acute pancreatitis[J].2013,108(9).
- [14]J J, Prorok,D R, Trostle.Early definitive surgery for acute pancreatitis associated with cholelithiasis.[J].1986,52(4).
- [15]Uhl W,Muller CA,Scholzel S,etc.Acute gallstone pancreatitis: timing of laparoscopic cholecystectomy in mild and severe disease.[J].1999,13(11).
- [16]J C, Marshall,D J, Cook,N V, Christou,etc.Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome.[J].1995,23(10).
- [17].IAP/APA evidence-based guidelines for the management of acute pancreatitis[J].2013,13(Supplement 2).
- [18]A. Gabbrielli,A. Zerbi,R. Pezzilli,etc.A prospective multicentre survey on the treatment of acute pancreatitis in Italy[J].2007,39(9).
- [19]Ozkan OV,Bas G,Sahin M,etc.Timing of cholecystectomy for acute biliary pancreatitis: outcomes of cholecystectomy on first admission and after recurrent biliary pancreatitis.[J].2003,27(3).
- [20]Frey DM,Hamel CT,Oertli D,etc.Early versus delayed cholecystectomy in patients with biliary acute pancreatitis.[J].2009,145(3).
- [21]Whigham C,Polignano FM,Sanjay P,etc.Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP).[J].2008,22(8).
- [22]E J Balthazar,J H Ranson,D P Naidich,etc.Acute pancreatitis: prognostic value of CT.[J].1985,156(3).
- [23]SarathiPatra,P.,Das,K.,Bhattacharyya,A.,etc.Natural resolution or intervention for fluid collections in acute severe pancreatitis[J].2014,101(13).
- [24]Stefan A, Bouwense,Marc G, Besselink,Sandra, van Brunschot,etc.Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial): study protocol for a randomized controlled trial.[J].2012,13.