妊娠合并急性胆源型胰腺炎的内镜治疗  

Endoscopic therapy for acute biliary pancreatitis during pregnancy

作　　者：龙建武[1] 周筱筠[1] 孙鑫国[1] 刘龙飞[1] 卢先州[1] 李卫[1] 徐志广[1] 

机构地区：[1]南华大学附属南华医院普通外科,湖南衡阳421002

出　　处：《中国普通外科杂志》2015年第3期385-388,共4页China Journal of General Surgery

基　　金：湖南省高校科研基金资助项目(12C0353)

摘　　要：目的:探讨内镜治疗妊娠合并急性胆源性胰腺炎(ABP)的临床价值和安全性。方法:回顾性分析2000―2014年期间收治的35例妊娠合并ABP患者的临床资料,其中13例患者选择药物保守治疗(保守组),另22例患者均在明确诊断后48 h内行内镜微创治疗(内镜组)。结果:保守组9例(69.2%)孕妇治愈,孕妇死亡4例(30.8%),胎儿死亡6例(46.2%)。内镜组19例(86.4%)孕妇治愈,其中行乳头括约肌切开取石(EST)治愈者12例,内镜下鼻胆管引流(ENBD)治愈者2例,ENBD后腹腔镜治愈者4例,1例经内镜治疗病情加剧,紧急开腹手术并终止妊娠后治愈,胎儿死亡;3例孕妇(13.6%)死亡,其中1例内镜治疗失败转开腹,后因胰瘘母婴死亡,2例因并发多器官功能衰竭母婴死亡。内镜组孕妇及胎儿病死率明显低于保守组(均P<0.05),此外,两组治疗3d后的各项实验室指标改善情况,内镜组均优于保守组(均P<0.05)。结论:妊娠合并ABP患者早期内镜介入治疗安全有效。Objective：To investigate the clinical value and safety of endoscopic therapy for acute biliary pancreatitis（ABP）during pregnancy.Methods：The clinical data of 35 women with ABP treated from 2000 to 2014 were retrospectively analyzed.Of the patients,13 cases received conservative treatment（conservative group）,and the other 22 cases received minimally invasive endoscopic treatment within 48 h after definite diagnosis was made（endoscopic group）.Results：In conservative group,9 pregnant women（69.2%） were cured,4 pregnant women（30.8%） died,and fetal death occurred in 6 cases（46.2%）.In endoscopic group,19 pregnant women（86.4%） were cured,of whom12 cases were cured by endoscopic sphincterotomy（EST）,2 cases were cured by endoscopic nasobiliary drainage（ENBD） and 4 cases were cured by laparoscopic treatment after ENBD,and one case whose condition worsened after endoscopic treatment underwent emergent open surgery and termination of pregnancy,and then recovered but the fetus died;3 pregnant women（13.6%） died,of whom one case underwent open conversion due to failure of endoscopic treatment,and then developed pancreatic fistula that caused both maternal and fetal death,and 2cases developed multiple organ failure that caused both maternal and fetal death.The maternal and fetal mortality in endoscopic group were significantly lower than those in conservative group（both P〈0.05）,moreover,the degree of improvement of laboratory parameters in endoscopic group was better than that in conservative group at3 d after treatment（all P〈0.05）.Conclusion：Early endoscopic intervention for ABP patients during pregnancy is safe and effective.

关 键 词：胰腺炎 妊娠 外科手术 微创性 

分 类 号：R657.5[医药卫生—外科学]