Abstract: The timing and selection of surgical methods in the treatment of acute biliary pancreatitis        LU Tian-qi, SUN Bei.   Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University, Key Laboratory of Hepatosplenic Surgery（Ministry of Education）, Harbin 150001,  China
Corresponding author：SUN Bei，E-mail：sunbei70@tom.com
Abstract    Surgical intervention plays an important role in the treatment of acute biliary pancreatitis (ABP). In recent years, with the development of medical technology, the concept of surgical treatment of ABP has changed greatly, showing the characteristics of minimally invasive, individualized and professional. In the face of the complex condition of ABP, it is very important for surgeons whether, when and how to operate. However, there are still some differences in opinions at home and abroad. For ABP patients with cholangitis or biliary obstruction, early endoscopic retrograde cholangiopancreatography (ERCP) should be performed to relieve biliary obstruction and prevent the progression of ABP. However, routine early ERCP is not recommended for patients without cholangitis or biliary obstruction. It is suggested that cholecystectomy should be performed in the early stage of ABP to prevent recurrence of ABP. For patients with severe ABP, the operation should be delayed as far as possible, and the gallbladder should be resected when the condition is stable. Surgeons should follow the law of disease development and choose the right operation time and method according to different patients' conditions.

Key words: biliary pancreatitis, endoscopy, cholecystectomy, operation timing

摘要： 外科干预在急性胆源性胰腺炎（ABP）的治疗中占有重要地位。近年来，随着医学技术的发展，ABP的外科治疗理念发生了很大变化，呈现出微创化、个体化、专业化的特点。面对ABP复杂的病情，是否手术，何时手术，怎样手术，对外科医生来说至关重要。但目前国内外对该方面的意见仍存在一定分歧。对于合并有胆管炎或胆道梗阻的ABP病人应早期行内镜逆行胰胆管造影（ERCP）解除胆道梗阻，阻止ABP病情进展，而无胆管炎或胆管梗阻表现的病人不建议行常规早期ERCP。轻中度ABP病人均建议在发病早期切除胆囊，防止ABP复发。而对于重症ABP病人，手术治疗应尽量延期进行，在病情平稳的情况下再切除胆囊。外科医生应该遵从疾病发展的规律，针对不同病人病情，正确选择手术时机和手术方式。

关键词: 胆源性胰腺炎, 内镜, 胆囊切除术, 手术时机