妊娠合并重症急性胰腺炎的诊治分析  

Clinical analysis of diagnosis and treatment of severe acute pancreatitis in pregnancy

作　　者：谢茂云[1] 黄耀[1] 陈衡[1] 张卫星[1] 杨莉涛[1] 魏扬辉[1] 

机构地区：[1]广东医学院附属福田人民医院,广东深圳518033

出　　处：《中国现代医学杂志》2011年第29期3705-3707,共3页China Journal of Modern Medicine

摘　　要：目的探讨妊娠合并重症急性胰腺炎的临床特点、诊治及胎儿的处理。方法回顾性分析2006年1月～2010年12月收治的9例妊娠合并重症急性胰腺炎患者的临床资料,其中妊娠合并重症急性结石性胰腺炎(severe acute gallstone pancreatitis,SAGP)6例,妊娠并发高血脂性重症急性胰腺炎(hyperlipidemic severe a-cute pancreatitis,HLSAP)3例。结果 9例患者均诊断为妊娠合并重症急性胰腺炎。包括经纤维十二指肠镜下行Oddi括约肌鼻胆管引流、血液透析滤过联合血浆置换在内的非手术治疗6例,手术治疗3例。9例患者均恢复,其中1例孕29周入院前胎死宫内,行死胎引产术;3例早产;5例治愈后足月产。结论对于胰胆管有梗阻患者,及时经纤维十二指肠镜下行Oddi括约肌鼻胆管引流治疗妊娠合并SAGP;对于高脂血症性胰腺炎患者及早行血液透析滤过联合血浆置换治疗妊娠合并HLSAP是较好的手段;妊娠合并重症急性胰腺炎不需立即终止妊娠,应注意严密监测和保胎处理。[Objective] To explore the clinical features, diagnosis, therapy and the fetus handling of severe acute pancreatitis in pregnancy （SAPIP）. [Methods] The clinical data of 9 cases of SAPIP treated in our hospital from January 2006 to October 2010 were retrospectively analyzed.Among the 9 cases of SAPIP, there were 6 （66.7%） cases of severe acute gallstone pancreatitis （SAGP） and 3 （33.3%） cases of hyperlipidemie severe acute panereatitis （HLSAP）. [Results] Six （66.7%） patients received conservative therapy and three （33.3%）, surgical operations.A total of 9 （100%） patients recovered. The mortality during pregnancy was 11.1% （1 case） for,the fetuses.preterm delivery rate was 33.3% （3 case）, 3 cases received termination of pregnancy and 5 continued their pregnancy. [Conclusions] Endoscopic retrograde cholangiopancreatograph （ERCP） to treat pregnancy complicated with gallstone in severe acute pancreatitis patients and the hemodiafiltration with plasmapheresis to treat pregnancy complicated with hyperlipemia in severe acute pancreatitis patients is a better way. SAP1P is not need to terminate pregnancy at once, but to observe and monitor closely and protect fetus.

关 键 词：妊娠 胰腺炎 高脂血症 胆石症 

分 类 号：R714.1[医药卫生—妇产科学] R576[医药卫生—临床医学]