15例妊娠期急性胰腺炎患者临床分析  

Clinical analysis on 15 patients with acute pancreatitis in pregnancy

作　　者：许剑萍[1] 于进[2] 张岩[2] 

机构地区：[1]河北省石家庄市第五医院妇产科,050000 [2]北京大学第一医院

出　　处：《中国妇幼保健》2015年第9期1343-1346,共4页Maternal and Child Health Care of China

摘　　要：目的：探讨妊娠期急性胰腺炎（APIP）的病因、临床特点、治疗及预后。方法：收集1995年2月~2013年7月北京大学第一医院收治的15例APIP患者的临床资料,分析其临床特点。结果：15例妊娠合并急性胰腺炎的患者中轻症10例、重症5例。主要临床表现为持续性上腹部疼痛及剑突下疼痛（14例）;消化道症状如恶心、呕吐（11例）,发热（4例）,中上腹压痛（11例）,腹膜炎体征（6例）,乳糜血（3例）。5例合并高脂血症、脂肪肝,5例合并胆囊炎、胆道结石。早孕期3例、中孕期3例、晚孕期8例、产褥期1例。4例患者保守治疗成功后继续妊娠;6例行剖宫产术,其中1例同时行胆囊切除术＋胰腺坏死感染组织清除术＋鼻胆管引流术,3例患者术后行血液透析滤过联合血浆置换治疗。11例新生儿中2例放弃治疗,其他9例均存活。结论：胆道疾病及高脂血症是APIP的重要病因,早期诊断和正确治疗是影响预后的关键。Objective： To explore the etiology,clinical characteristics,treatment and prognosis of acute pancreatitis in pregnancy（ APIP）. Methods： The clinical data of 15 patients with APIP treated in the First Hospital of Beijing University from February 1995 to July 2013 was collected,then the clinical characteristics were analyzed. Results： Among 15 patients with APIP,10 patients were mild and 5 patients were severe. The main clinical manifestations were persistent abdominal pain and subcostal pain（ 14 /15）,gastrointestinal symptoms such as nausea and vomiting（ 11 /15）,fever（ 4 /15）,abdominal tenderness（ 11 /15）,peritoneal inflammatory signs（ 6 /15）,and chylemia（ 3 /15）. Five patients were complicated with hyperlipidemia and fatty liver,and five patients suffered from cholecystitis and cholelithiasis.In all 15 patients,there were 3 patients in early pregnancy,3 patients during the second trimester of pregnancy,8 patients in late pregnancy,and one patient in puerperium. Four patients continued pregnancy successfully after conservative treatment. Six patients accepted cesarean section,one of which received cholecystectomy,endoscopic nasobiliary drainage and removal surgery of infected pancreatic necrosis tissue at the same time. After operation,3 patients received blood dialysis filtration combined with plasma exchange. Two of the 11 neonates died because of giving up treatment,and the other 9 neonates were alive. Conclusion： Biliary diseases and hyperlipidemia are important causes of APIP. Early diagnosis and correct treatment may be the key influencing factors of prognosis.

关 键 词：妊娠 急性胰腺炎 乳糜血 高脂血症 

分 类 号：R714.255[医药卫生—妇产科学]