妊娠合并急性胆源型胰腺炎的内镜治疗

发布时间：2018-08-04 16:00

【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P0.05),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P0.05)。结论:妊娠合并ABP患者早期内镜介入治疗安全有效。
[Abstract]:Objective: to evaluate the clinical value and safety of endoscopic treatment of pregnancy with acute biliary pancreatitis (ABP). Methods: the clinical data of 35 cases of pregnancy complicated with ABP from 2000 to 2014 were analyzed retrospectively. Among them, 13 cases were treated with conservative drug therapy (conservative group), the other 22 cases were treated with endoscopic minimally invasive therapy (endoscopic group) within 48 hours after definite diagnosis. Results: in conservative group, 9 cases (69.2%) were cured, 4 cases (30.8%) died of pregnant women and 6 cases (46.2%) died of fetus. In endoscopic group, 19 cases (86.4%) were cured, 12 cases were cured by sphincterotomy of papillary sphincter, 2 cases were cured by endoscopic nasobiliary drainage (ENBD), 4 cases were cured by endoscopy and 1 case was aggravated by endoscopic treatment. 3 cases (13.6%) died of fetal death after emergency operation and termination of pregnancy. One case was converted to laparotomy after endoscopic treatment, and 2 cases died of multiple organ failure due to pancreatic fistula. The mortality of pregnant women and fetus in the endoscopic group was significantly lower than that in the conservative group (P0.05). In addition, the improvement of laboratory indexes in the two groups after 3 days treatment was better than that in the conservative group (P0.05). Conclusion: early endoscopic interventional therapy for pregnancy with ABP is safe and effective.
【作者单位】：南华大学附属南华医院普通外科;
【基金】：湖南省高校科研基金资助项目(12C0353)
【分类号】：R714.255

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