临床研究(Clinical Research)

妊娠合并急性胆源型胰腺炎的内镜治疗

Published at: 2015年第24卷第3期

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
1 南华大学附属南华医院 普通外科,湖南 衡阳 421002
通讯作者 建武 龙 Email: longjianwu0918@126.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.03.015
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 3 d 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。


Endoscopic therapy for acute biliary pancreatitis during pregnancy

Abstract

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 whom 12 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 2 cases 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 at 3 d after treatment (all P<0.05). Conclusion: Early endoscopic intervention for ABP patients during pregnancy is safe and effective.


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引用

引用本文: 建武 龙, 筱筠 周, 鑫国 孙, 龙飞 刘, 先州 卢, 卫 李, 志广 徐. 妊娠合并急性胆源型胰腺炎的内镜治疗[J]. 中国普通外科杂志, 2015, 24(3): 385–388.
Cite this article as: LONG Jianwu, ZHOU Xiaojun, SUN Xingguo, LIU Longfei, LU Xianzhou, LI Wei, XU Zhiguang . Endoscopic therapy for acute biliary pancreatitis during pregnancy[J]. Chin J Gen Surg, 2015, 24(3): 385–388.