The Therapy Of Acute Biliary Pancreatitis: A Report Of 85 Cases

OBJECTIVES:The purpose of this study was to summarize characteristics and the therapeutic experience of acute biliary pancreatitis. METHODS:The clinical data of 85 cases with acute biliary pancreatitis who went to Qianfoshan hospital of Shandong province from January 1st,2005 to December 31st,2009 analyzed retrospectively. Then the cases were divided into four groups according to patient's conditions and whether the bile duct were obstructed. In the majority of patients,70 cases were mild acute pancreatitis (MAP), involving 52 cases (group I) whose bile ducts were not obstructed and 18 cases (group II) whose bile ducts were obstructed. Fifteen cases were severe acute pancreatitis (SAP), involving 9 cases (group III) whose bile ducts were not obstructed and 6 cases (group IV)whose bile ducts were obstructed. All cases received the conservative treatment after dmission. Meanwhile, 24 cases whose bile ducts were obstructed underwent emergency operation. Twelve cases received encoscopic retrograde cholangio-pancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic nasobiliary draingage (ENBD). Endoscopictherapy can clear bile duct stones. Twelve cases received open operations. Nine patients received cholecystectomy, common bile duct explorationand T-tube drainage,3 patients underwent cholecystectomy, common bile duct cyst excisionandbile duct jejunum Roux-en-Y anastomosis. Then compare hospitalstays and complication of different treatments in patients. Then the sofeware of SAS 9.1 was used to analyze the datas. RESULTS:(1) Sixty-one cases without biliary obstruction improved after conservative treatment.Pancreatic pseudocyst, pancreatic abscess and pancreatic necrosis and other complications did not occur in 52 cases of MAP. The average hospital stay was 15.48±9.31 days. Two patients of SAP suffered from pancreatic pseudocyst after treatment. No other complications was found. The average hospital stay was 32.9±18.13 days. (2) Twelve cases associated with biliary obstruction received endoscopic treatment.Common bile duct stones were found after ERCP and cleared in the same time. No postoperative complications occurred, the average hospital stay was 19.17±9.8 days. Twelve cases received open operations. Nine patients received cholecystectomy, common bile duct explorationand T-tube drainage,3 patients underwent cholecystectomy, common bile duct cyst excisionandbile duct jejunum Roux-en-Y anastomosis. Postoperative incision fat liquefaction occured in 2 cases. Residual stones were seen by postoperative T tube cholangiography in 3 cases. They were removed by cholangioscopy. No other postoperative complications occurred. The average hospital stay was 27.67±11.7 days. The differences of hospitalstays and complication betweentwo groups were significant (P< 0.05). CONCLUSIONS:(1) When acute biliary pancreatitis associated with biliary obstruction has been confirmed, conservative treatment.should follow by operations which release the bile obstruction. Unobstructed drainage treatments are very important. Endoscopic treatment which is characterized by minimal injury, effective nessand sequentialprocess is superior to open surgery. (2) With the development of new effective antibiotic drugs, intravenous nutrition and other relevant adjuvant therapy, the therapy of acute biliary pancreatitis gets great achievements. ABP without biliary obstruction improved after conservative treatment. Symptoms gradually disappear, and all laboratory markers returned to normal.