Clinical classification and timing of surgery for gallstone acute pancreatitis / 中国普通外科杂志

ABSTRACT

Objective To evaluate the clinical classification and timing of surgery in the treatment of gallstone acute pancreatitis(GAP). Method The clinical data of 109 patients with GAP admitted to the Department of General Surgery of our hospital were retrospectively analysed. Result and Conclusion Based on the analysis of the treatment methods and its outcome, GAP should be divided into four types according to ampullary obstruction and severity of acute pancreatitis. (1)Non-obstructive mild type GAP was treated mainly in conservative way.(2)Obstructive mild type GAP could be treated conservatively for 36 hours after onset. If the obstruction did not resolve, surgery should be done. (3)Obstructive severe type GAP was treated mainly in conservative way, and the timing of surgery depends on whether necrosis complicated with infection. (4)Obstructive severe type GAP EST should be done first. If EST is not convenient to be done, an early surgery should be done after short period of supportive therapy. Special attention should be paid to, if suppurative cholecystitis or cholangitis presented, an emergency surgery should be done. Finally, for all the GAP treated by conservative treatment, an elective surgery should be performed to resolve the biliary disease.