Management And Opportunity Of Operation In Obstructive Acute Biliary Pancreatitis

ObjectiveAcute biliary pancreatitis(ABP) is the most common type of pancreatitis,accounts for 40% of pancreatitis cases diagnosed worldwide.Proposed mechanisms for ABP pathogenesis include reflux of bile into the pancreatic duct or transient obstruction of the ampulla of Vater by biliary sludge or stone.At present,the diagnosis and treatment of acute pancreatitis has been accepted widely.However,treatments for acute biliary pancreatitis,especially for obstructive acute biliary pancreatitis,for examples,the selection of endoscopic or surgical treatment and the opportunity of operation are still have no consensus.The purpose of this study is to investigate the management and opportunity of operation in obstructive acute biliary pancreatitis. MaterialA retrospective review was performed of seventy-six consecutive patients(31 men,45 women;median age,62 years;age range,20-93 years) who presented to a single tertiary care institution from 2000 to 2010 with obstructive acute biliary pancreatitis.Methods1. Patients with obstructive acute biliary pancreatitis were divided into three groups depending on the option of treatment methods.(non-operation treatment group,Endoscopic treatment group,operation group).Assessing the influence of the therapeutic efficacy and disease recurrence between the three groups.In addition,the operation group was divided into two groups(Early operation group and Postponed operation group) according to the opportunity of operation for dealing the biliary and pancreatitis diseases.The surgical complication incidence, mortality and average hospitalization days were assessed in different operational time between the two groups.2. All date were expressed as means values±SD and analysis with SPSS 16.0.Differences were considered significant if the P value was less than 0.05,using an unpaired Student's t test,a single factor analysis of variance or a chi-square test.ResultsOf the 76 patients after treatment, 74 cases were cured, 2 cases were died.The complication rates of the three groups were 36.0%,13.0%,and 11.0%,respectively.Mortality rate were 4.0%,0.0% and 2.7% respectively.The rate of recurrent biliary AP were 24.0%,6.7%,0.0% respectively.Greater rates of complication and recurrent biliary pancreatitis were found in the non-operation treatment group ( P= 0.04,and P = 0.005).In the operation group , there is a longer average hospitalization days of the patient who undergoing operation later.Conclusion(1)Operation is an essential treatment option in management of acute biliary pancreatitis.(2)In cases of obstructive acute biliary pancreatitis,early operation or endoscopic therapy should be performed to remove biliopancreatic obstruction after aggressive conservative treatment.(3)Options for application of endoscopic therapy or operation to remove biliopancreatic obstruction mainly depends on the course of severity,biliary diseases and systemic organ function.(4)After removing the biliopancreatic obstruction,cholecystectomy can be undergoing if the pancreatitis symptoms was gone and amylase value was fall.