Evolving management of mildtomoderate gallstone pancreatitis

The objective of this study was to describe recent trends in the management of mild-to-moderate gallstone pancreatitis and assess patient outcomes. Acute gallstone pancreatitis has traditionally been managed with open cholecystectomy and intraoperative cholangiography during the initial hospitalization. The popularization of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy has made a reassessment necessary. Two consecutive time periods were retrospectively analyzed: prior to laparoscopic cholecystectomy (prelaparoscopic era [PLE]) and after the diffusion of laparoscopic cholecystectomy (laparoscopic cholectomy era [LCE]). There were 35 patients in the PLE group and 58 in the LCE group. LCE patients waited 37.1 +63 days from admission until cholecystectomy, compared to 9.8 +14.8 days in the PLE group (P = 0.04). Biliary-pancreatic complications occurred in 24% of LCE patients and only 6% of PLE patients (P = 0.05), nearly always while they were awaiting cholecystectomy (P = 0.009). Patients in either time period who underwent cholecystectomy with intraoperative cholangiography developed less pancreatic-biliary complications than those who underwent ERCP prior to cholecystectomy, with or without sphincterotomy. Delaying the interval from pancreatitis to laparoscopic cholecystectomy beyond historical values is associated with a greater risk of recurrent biliary-pancreatic complications, which are not prevented by the use of ERCE Early cholecystectomy with intraoperative ductal evaluation is still the approach of choice. Drs. J.S. Barkun and A.N. Barkun are Chercheurs Cliniciens Boursier of the Fonds de la Recherche en Sant6 du Qurbec. Dr. S.M. Mehta is the recipient of an American Digestive Health Foundation/American Society of Gastrointestinal Endoscopy Training Award.     

Preoperative endoscopic retrograde cholangiopancreatography (ERCP) is not necessary in mild gallstone pancreatitis

Background: The role of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis is unclear. Therefore, we designed a study to establish whether ERCP is indicated in these cases. Method: We studied 55 patients who had been admitted with gallstone pancreatitis. All of them had mild pancreatitis (Ranson's criteria <3). ERCP was carried out within 4 days of admission, once the liver function tests and serum amylase had returned to normal levels. Results: ERCP did not demonstrate common bile duct stones in any of the patients. All patients then underwent laparoscopic cholecystectomy during the same admission. Conclusion: Preoperative ERCP is not indicated for patients with mild gallstone pancreatitis. Received: 9 June 1998/Accepted: 7 March 1999     

Effect of intraoperative cholangiography during cholecystectomy on outcome after gallstone pancreatitis

Acute gallstone pancreatitis has traditionally been managed by early cholecystectomy with intraoperative cholangiography (IOC). To evaluate the effect of IOC on patient outcome, we analyzed all patients operated on for acute gallstone pancreatitis at our institution over a 3-year period. A total of 200 patients (37 open, 163 laparoscopic) were evaluated. Nineteen of 34 patients who underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) were found to have common bile duct (CBD) stones. The 59 patients who underwent cholecystectomy with IOC had significantly longer operative times compared to the 141 patients who underwent cholecystectomy alone (167 vs. 105 minutes for open [P= 0.008] and 89 vs. 68 minutes for laparoscopic [P< 0.0001] operations). Of the 59 patients who underwent IOC, only nine (15%) had abnormal cholangiograms, and CBD exploration in seven revealed stones in four patients, edematous ampullae in two, and no abnormality in one. Six of eight patients (5 IOC, 3 no IOC) who required immediate postoperative ERCP were noted to have CBD stones. Patients who underwent IOC had significantly longer postoperative hospital stays (3.8 vs. 2.0 days [P= 0.007]). The incidence of retained CBD stones following surgery was similar (5.1% IOC, 2.8% no IOC). Although 7 of 122 patients who underwent laparoscopic cholecystectomy without IOC were readmitted, only one was found on ERCP to have a retained CBD stone. Age, sex, preoperative days, procedure type, and biliary-pancreatic complications after discharge did not differ significantly between patients with and without IOC. We conclude that IOC in patients operated on for acute gallstone pancreatitis results in a longer operative time and a prolonged postoperative course, but has no effect on the incidence of retained CBD stones. Presented at the Annual Meeting of the Southern California Chapter of the American College of Surgeons, Huntington Beach, California, January 21–23, 2000.     

Endoscopic sphincterotomy permits interval laparoscopic cholecystectomy in patients with moderately severe gallstone pancreatitis

Patients with moderately severe gallstone pancreatitis with substantial pancreatic and peripancreatic inflammation, but without organ failure, frequently have an open cholecystectomy to prevent recurrent pancreatitis. In these patients, prophylactic endoscopic retrograde cholangiography (ERC) with endoscopic sphincterotomy (ES) may prevent recurrent pancreatitis, permit laparoscopic cholecystectomy, and decrease risks. The medical records of all patients with pancreatitis undergoing cholecystectomy from 1999–2004 at the University of North Carolina Memorial Hospital were reviewed. Data regarding demographics, clinical course, etiology of pancreatitis, operative and endoscopic interventions, and outcome were extracted. Moderately severe gallstone-induced pancreatitis was defined as pancreatitis without organ failure but with extensive local inflammation. Thirty patients with moderately severe gallstone pancreatitis underwent ERC and ES and were discharged before cholecystectomy. Mean interval between ES and cholecystectomy was 102 ± 17 days. Cholecystectomy was performed laparoscopically in 27 (90%) patients, open in three (10%) patients, and converted to open in two (7%) patients, with a morbidity rate of 7% (two patients). No patient required drainage of a pseudocyst or developed recurrent pancreatitis. Interval complications resulted in hospital readmission in seven (23%) patients. In conclusion, recurrent biliary pancreatitis in patients with moderately severe gallstone pancreatitis is nil after ERC and ES. Hospital discharge of these patients permits interval laparoscopic cholecystectomy, but close follow-up is necessary in these potentially ill patients. Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18, 2005 (poster presentation).     

The impact of timing of cholecystectomy following gallstone pancreatitis

IntroductionCurrent guidelines for the management of acute gallstone pancreatitis recommend cholecystectomy as definitive treatment during primary admission or within 2 weeks of discharge, with the aim of preventing recurrent pancreatitis. However, cholecystectomy during the inflammatory phase may increase surgical complication rates. This study aimed to determine whether adherence to the guidelines prevents recurrent pancreatitis while minimising surgical complications.MethodsMulti-centre review of seven UK hospitals, indentifying patients presenting with their first episode of gallstone pancreatitis between 2006 and 2008.ResultsA total of 523 patients with gallstone pancreatitis were identified, of which 363 (69%) underwent cholecystectomy (72 during the primary admission or within 2 weeks of discharge; 291 following this). Overall, 7% of patients had a complication related to cholecystectomy of which a greater proportion occurred when cholecystectomy was performed within guideline parameters (13% vs 6%; p = 0.07). 11% of patients were readmitted with recurrent pancreatitis prior to surgery, with those undergoing cholecystectomy outside guideline parameters being most at risk (p = 0.006).ConclusionThis study suggests cholecystectomy within guideline parameters significantly reduces recurrence of pancreatitis but may increase the risk of surgical complications. A prospective randomised study to assess the associated morbidity is required to inform future guidelines.     

Financial Burden Secondary to Delay in Cholecystectomy Following Mild Biliary Pancreatitis

Aim of the study: The guidelines recommend that patients with mild gallstones pancreatitis should undergo a definitive management for gallstones during the same admission or within the next two weeks. The aim of this study was to estimate the financial cost resulting from a delay in surgical management following mild gallstones pancreatitis. This includes the costs of readmissions with biliary events and the subsequent investigations required during these admissions. Materials and methods: A retrospective analysis included patients with gallstone pancreatitis who were admitted to a district general hospital in the United Kingdom over one year. Patients with severe pancreatitis and those unfit for surgery were excluded. Results: Forty patients were included in the study, 27 females (67%) and 13 males (33%). Mean age was 50.2 years. Twenty-two patients of the total presented with a single admission with gallstone pancreatitis prior to an elective surgery; however, 18 patients (45%) required recurrent admissions. The duration between the first admission and surgery ranged from 14 to 389 days (median of 99 days). Only one patient (2.5%) had cholecystectomy within two weeks of admission as per guidelines. Twenty-two ultrasound scans, four computed tomography scans, 15 magnetic resonance cholangiopancreatography, and two endoscopic retrograde cholangiopancreatography were the total of the extra-investigations required during readmissions. Estimated costs of extra admissions and extra investigations exceeded £33,000. Conclusions: The delay in cholecystectomy for patients admitted with mild gallstone pancreatitis and fit for surgery has resulted in high readmission rate with biliary events, and subsequently high extrax costs.     

Acute biliary pancreatitis

Since January 1990, we have treated 113 patients for gallstone pancreatitis; 59 with laparoscopic cholecystectomy (LC), 50 with open cholecystectomy, and 4 with ERCP/sphincterotomy only. In the LC group, 47 had LC during the index admission and 12 underwent delayed LC. Fifty patients had open cholecystectomy, 47 during the index admission. ERCPs were performed in 43 of the 113 patients; CBD stones were identified in 19/43 (44%) and removed endoscopically in 18 (95%). The ERCP complication rate was 6.5%. In total, CBD stones were identified in 29/113 patients (26%). Patients who had imaging of the CBD within the first 4 days from onset of symptoms were more likely to have stones identified than were those patients who were studied after 5 days. Recurrent pancreatitis occurred in five of 11 patients (45%) who had a 30-day delay to definitive treatment. We conclude that LC can be safely performed in most patients during the index admission for gallstone pancreatitis. This policy should reduce the 30–50% risk of recurrent pancreatitis associated with a delayed operation. ERCP is a helpful adjunct for CBD stones.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Nashville, TN, USA, 18–19 April 1994     

Minimally invasive approach in gallstone disease complicated with acute pancreatitis

We have evaluated the minimally invasive approaches (laparoscopy, endoscopy) in the management of the gallstone disease complicated with acute pancreatitis. Hypothesis. Emergency ERCP in gallstone pancreatitis (GSP) associated with jaundice or angiocholitis has a beneficial effect on pancreatic inflammation, eventually favoring laparoscopic cholecystectomy. We have compared 18 cases of emergency ERCP for GSP associated with jaundice or angiocholitis (Group 1) with 72 cases of GSP where ERCP was indicated on a selective basis (Group 2). Laparoscopic cholecystectomy was done after the acute bout of pancreatitis subsided. The minimally invasive approaches were completed in 89% cases in Group1 and in 90% cases in Group 2, respectively. Pancreatic morbidity was better in Group 1 (0% vs. 15.2%), but without statistical significance. General morbidity was significantly lower (0% vs. 23.6%) as well as the mean hospital stay (13 +/- 5.5 days vs. 17 +/- 10.4 days). Only the lower general morbidity and the shorter hospital stay assert the hypothesis that emergency ERCP in GSP associated with jaundice or angiocholitis has a beneficial effect on pancreatic inflammation, eventually favoring laparoscopic cholecystectomy.     

轻型胆源性胰腺炎患者早期和延期行腹腔镜胆囊切除术的meta分析

目的 评价和比较轻型胆源性胰腺炎患者在入院48 h内（早期组）与入院48 h后（延期组）行腹腔镜下胆囊切除术的安全性和有效性。方法 计算机检索PubMed、Cochrane Library、Embase上搜索所有相关的英文文献（1990年1月至2015年1月）,并运用RevMan5.3软件进行统计学分析。结果 共纳入5篇 文献（3 篇观察性试验,2 篇随机对照试验）,共679 例患者。Meta结果显示,与延期组相比,早期组在ERCP的总共使用上少于延期组（OR =0.54,95%CI：0.36～0.80,P =0.002）。二者在术后并发症、中转开腹率、术后ERCP的使用和再入院率方面差异无统计学意义（P ＞0.05）。虽然在住院时间上缺乏数据进行Meta分析,但每篇文献均显示早期组少于延期组,差异具有统计学意义（P ＜0.05）。未有死亡病例发生。结论 对于轻型胆源性胰腺炎患者,入院48 h内进行腹腔镜下胆囊切除术是安全、有效的。     

Surgeons provide definitive care to patients with gallstone pancreatitis

Background

The optimal management of patients with gallstone pancreatitis (GP) remains a matter of debate. There are wide variations in the use of diagnostic testing and same-stay cholecystectomy. We hypothesize that a general surgery service (SURG) will deliver more efficient, definitive care for patients with GP.

Methods

A retrospective cohort study of consecutive GP patients in an urban hospital from 2006 to 2009. Differences between groups were assessed by the two-tailed Student t test for continuous variables and the Fisher exact test for ordinal data.

Results

One hundred twenty-four patients with GP were admitted, 79 to medicine (MED) and 45 to surgery (SURG). In the MED group, 21 patients (27%) underwent same-stay cholecystectomy, and 7 patients (9%) returned with recurrent biliary pancreatitis. In the SURG group, 44 patients had definitive surgery, and none returned with recurrent disease (P < .01 and .09, respectively). The SURG group had fewer laboratory tests, antibiotics, and consultations.

Conclusions

For patients with GP, admission to surgery results in definitive treatment with same-stay cholecystectomy. This is a more efficient approach with fewer readmissions for the same disease process.     

Endoscopic sphincterotomy for prevention of the recurrence of acute biliary pancreatitis in patients with gallbladder in situ: long-term follow-up of 88 patients

Background Endoscopic sphincterotomy without cholecystectomy is a therapeutic option in selected patients after acute biliary pancreatitis. We conducted a prospective evaluation of the long-term effects of sphincterotomy in terms of the need for of subsequent cholecystectomy and the recurrence of gallstone pancreatitis.Methods We studied 88 patients with acute biliary pancreatitis and an intact gallbladder who, underwent endoscopic sphincterotomy either because they were high-risk candidates for surgery or because they had refused of cholecystectomy. The median follow-up was 51 months (range, 5–86).Results Only two patients (2.2%) experienced recurrent pancreatitis. Subsequent cholecystectomy was performed in 10 patients because of acute cholecystitis in eight cases and biliary colic in two cases. Sixty-six patiens (75%) remained asymptomatic.Conclusions Endoscopic sphincterotomy is a safe and acceptable alternative to cholecystectomy for the prevention of recurring attacks of gallstone pancreatitis. As a result of this procedure, 75% of patients remained free of symptoms in the long term.     

Laparoscopic cholecystectomy and interventional endoscopy for gallstone complications during pregnancy

Background: Symptomatic or complicated gallstone disease is the most common reason for nongynecological operations during pregnancy. Gallstones are present in 12% of all pregnancies, and more than one-third of patients fail medical treatment and therefore require surgical endoscopy or laparoscopy. Gallstone pancreatitis and jaundice during pregnancy is associated with a high recurrence rate, exposing both fetus and mother to an increased risk of morbidity and mortality. Methods: During a 4-year period, all pregnant patients (n= 37) with symptomatic or complicated gallstone disease were studied prospectively at the Landeskrankenhaus in Salzburg, Austria. Five patients had an endoscopic retrograde cholangiopancreatogram (ERCP) for biliary pancreatitis or jaundice; two of these underwent subsequent laparoscopic cholecystectomy. Another seven patients required laparoscopic cholecystectomy for severe pain or cholecystitis; all were in their 13th–32nd gestational week. Access was established by Veress needle in all cases. Insufflation pressure was 8–10 mmHg, and mean operative time was 62 min. Results: All patients delivered full-term, healthy babies. There were no postendoscopic or postoperative complications. All patients enjoyed full relief from their symptoms; there were no recurrences of pancreatitis or jaundice. Conclusions: The combination of ERCP and laparoscopic cholecystectomy offers a safe and effective option for the definitive treatment of complicated gallstone disease and intractable pain during pregnancy, and there is sufficient access for the combined treatment to be employed. Received: 7 September 1998/Accepted: 2 June 1999     

Endoscopic sphincterotomy for the treatment of gallstone pancreatitis during pregnancy

Background: Gallstones are the most common cause of acute pancreatitis during pregnancy. Without intervention, gallstone pancreatitis during pregnancy is associated with an antepartum recurrence rate of 70%, which exposes the mother and fetus to an increased risk of morbidity and mortality. A safe, effective means to prevent recurrent gallstone pancreatitis during pregnancy is desirable. Methods: Since 1991, we have managed gallstone pancreatitis in three pregnant patients with endoscopic retrograde cholangiogram (ERC), followed by spincterotomy, despite the absence of common bile duct stones. Results: All patients were judged to have mild pancreatitis by modified Ranson criteria and the Multiorgan System Failure criteria. During cholangiogram, fetal shielding was employed and fluoroscopy times ranged from 36 s to 7.2 min. One patient experienced postprocedure pancreatitis of 48-h duration. None of the patients experienced further episodes of pancreatitis and none underwent predelivery cholecystectomy. Conclusions: In pregnancy-associated gallstone pancreatitis, endoscopic sphincterotomy prevents recurrence of pancreatitis and the need for cholecystectomy during gestation. We believe endoscopic sphincterotomy represents a promising management alternative for gallstone pancreatitis during pregnancy. Further investigation is warranted. Received: 30 December 1996/Accepted: 12 September 1997     

JPN Guidelines for the management of acute pancreatitis: treatment of gallstone-induced acute pancreatitis

Gallstones, along with alcohol, are one of the primary etiological factors of acute pancreatitis, and knowledge of the etiology as well as the diagnosis and management of gallstones, is crucial for managing acute pancreatitis. Because of this, evidence regarding the management of gallstone-induced pancreatitis in Japan was collected, and recommendation levels were established by comparing current clinical practices with optimal clinical practices. The JPN Guidelines for managing gallstone-induced acute pancreatitis recommend two procedures: (1) an urgent endoscopic procedure should be performed in patients in whom biliary duct obstruction is suspected and in patients complicated by cholangitis (Recommendation A); and (2) after the attack of gallstone pancreatitis has subsided, a laparoscopic cholecystectomy should be performed during the same hospital stay (Recommendation B).     

Acute gallstone pancreatitis in childhood.

Acute pancreatitis is rarely considered in the diagnosis of paediatric abdominal pain and can be misdiagnosed. Gallstones are uncommon in children and are a rare cause of pancreatitis. Trauma, infections and idiopathic causes are the commonest aetiological factors. Three cases of gallstone-induced acute pancreatitis with jaundice in children are reported which resolved with conservative treatment. The gallstones were managed by laparoscopic cholecystectomy with or without endoscopic retrograde cholangiopancreatography (ERCP). The three children had presented previously to a doctor with symptoms of gallstone disease but the diagnosis was missed. It is concluded that acute pancreatitis should be considered in children presenting as an emergency with abdominal pain. Children with recurrent attacks of upper abdominal pain should be investigated for gallstone disease so that the diagnosis is made before the development of potentially serious complications such as acute pancreatitis and jaundice.     

Recurrent acute biliary pancreatitis: the protective role of cholecystectomy and endoscopic sphincterotomy

Background  Recurrent attacks of acute biliary pancreatitis (RABP) are prevented by (laparoscopic) cholecystectomy. Since the introduction of endoscopic retrograde cholangiopancreaticography (ERCP), several series have described a similar reduction of RABP after endoscopic sphincterotomy (ES). This report discusses the different treatment options for preventing RABP including conservative treatment, cholecystectomy, ES, and combinations of these options as well as their respective timing. Methods  A search in PubMed for observational studies and clinical (comparative) trials published in the English language was performed on the subject of recurrent acute biliary pancreatitis and other gallstone complications after an initial attack of acute pancreatitis. Result  Cholecystectomy and ES both are superior to conservative treatment in reducing the incidence of RABP. Cholecystectomy provides additional protection for gallstone-related complications and mortality. Observational studies indicate that cholecystectomy combined with ES is the most effective treatment for reducing the incidence of RABP attacks. Conclusion  From the literature data it can be concluded that ES is as effective in reducing RABP as cholecystectomy but inferior in reducing mortality and overall morbidity. The combination of ES and cholecystectomy seems superior to either of the treatment methods alone. A prospective randomized clinical trial comparing ES plus cholecystectomy with cholecystectomy alone is needed.     

内镜、腹腔镜序贯治疗急性胆源性胰腺炎

目的总结内镜、腹腔镜序贯治疗急性胆源性胰腺炎的临床效果. 方法我院2000年3月～2003年6月收治急性胆源性胰腺炎54例.入院后24 h内54例行经内镜逆行性胰胆管造影(ERCP)及取石术,7例因Oddi括约肌狭窄加行EST.所有患者均放置鼻胆管引流,待胰腺炎恢复后,53例施行腹腔镜胆囊切除术(LC),其中2例中转开腹;1例因胰周脓肿行开腹胆囊切除,胰周坏死组织清除. 结果未发生与内镜操作有关的严重并发症及手术并发症.随访6个月～3年,无胰腺炎复发. 结论早期内镜治疗急性胆源性胰腺炎安全有效,待胰腺炎缓解后,序贯应用LC,可体现微创手术的优点,不失为目前较理想的治疗方法.     

Endoscopic,percutaneous and laparoscopic treatment for acute biliary pancreatitis

AIM OF THE STUDY: The aim of this study is to evaluate the results of acute gallstone pancreatitis treatment and to discuss indications in relation with the different forms of the disease. MATERIAL AND METHOD: From january 1992 to june 2001, 137 patients have been treated for an acute gallstone pancreatitis. Diagnostic criteria were given by the history, clinical examination, biochemical and radiological findings. After exclusion of patients with a systemic disease, a group of 129 patients have been enrolled in a treatment regimen with an endoscopic retrograde cholangiopancreatography (ERCP) and eventual sphincterotomy, a percutaneous US-guided cholecystostomy (PC) when necessary and an elective laparoscopic cholecystectomy. RESULTS: ERCP has been successfully performed in 121/129 patients. A PC has been performed in 5/8 patients of the failed endoscopic procedure and in 14 with acute cholecystitis. Retrograde and percutaneous cholangiographies showed main bile duct stones in 89 patients, a dilatation of the main bile duct without stones in 26 patients and a negative finding in 6 patients. An endoscopic sphincterotomy has been performed in 117 patients. A laparoscopic cholecystectomy has been performed in 118 patients. Mortality and morbidity rates were 1.6 and 10.3%, respectively. CONCLUSION: ERCP and sphincterotomy seem to be indicated in all patients observed during the first 72 hours. Endoscopic treatment and percutaneous procedure make it possible to reduce at a very low rate the cases with an unfavourable course of the disease. A definitive treatment may then be performed by the way of a laparoscopic cholecystectomy.     

Acute biliary pancreatitis. Therapeutic trends

BACKGROUND: Treatment of biliary pancreatitis includes suppression of the biliary cause by cholecystectomy and common bile duct clearance. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy for eradication of biliary stones and laparoscopic cholecystectomy (L.C.) for residual gallbladder stones would be ideal but were once considered to be contraindicated by most surgeons. The timing of definitive biliary tract surgery and the role of ERCP have been the focus of discussion in recent years. METHODS: During a two-year study period 51 patients with acute biliary pancreatitis were studied. Seven patients (14%) underwent emergency laparotomy, necrosectomy, cholecystectomy, exploration of the common bile duct and T-tube insertion, because unstable clinical conditions, with evidence of pancreatic and peripancreatic necrosis on CT-scan. Elective open cholecystectomy and CBD exploration were performed in 7 patients after the resolution of acute pancreatitis during the same hospital admission. RESULTS: Early ERCP and L.C. were associated with favourable outcomes. 33 patients underwent ERCP preoperatively: 17 within 72 hours of admission and 16 after signs of clinical improvement. Laparoscopic cholecystectomy performed 3-25 days after admission was successful in 27 of 29 patients. Postsphincterectomy bleeding occurred in one patient and was treated successfully by endoscopic epinephrine injection. For median hospital stay and recurrence there were statistical differences between early and delayed ERCP. CONCLUSIONS: ERCP and sphincterectomy have a certain role in conjunction with laparoscopic cholecystectomy in the management of patients with acute biliary pancreatitis, particularly in institutions where there is easy access to expert interventional endoscopic techniques. This policy should reduce the risk of cholangitis and recurrent pancreatitis.     

胆囊结石腹腔镜切除术后并发胆源性胰腺炎的因素探讨

目的:探讨胆囊结石腹腔镜切除术后并发胆源性胰腺炎的危险因素,为胆囊结石腹腔镜切除术临床应用提供参考.方法:随机抽样调查2017年3月至2019年3月本院行腹腔镜切除术的214例胆囊结石病例.收集病例一般资料、术后并发胆源性胰腺炎情况、胆囊结石病理情况、治疗相关因素等,单因素分析法分析一般资料、胆囊结石病理情况、治疗相关...