【摘要】：目的:探討內(nèi)鏡治療妊娠合并急性膽源性胰腺炎(ABP)的臨床價值和安全性。方法:回顧性分析2000 2014年期間收治的35例妊娠合并ABP患者的臨床資料,其中13例患者選擇藥物保守治療(保守組),另22例患者均在明確診斷后48 h內(nèi)行內(nèi)鏡微創(chuàng)治療(內(nèi)鏡組)。結(jié)果:保守組9例(69.2%)孕婦治愈,孕婦死亡4例(30.8%),胎兒死亡6例(46.2%)。內(nèi)鏡組19例(86.4%)孕婦治愈,其中行乳頭括約肌切開取石(EST)治愈者12例,內(nèi)鏡下鼻膽管引流(ENBD)治愈者2例,ENBD后腹腔鏡治愈者4例,1例經(jīng)內(nèi)鏡治療病情加劇,緊急開腹手術(shù)并終止妊娠后治愈,胎兒死亡;3例孕婦(13.6%)死亡,其中1例內(nèi)鏡治療失敗轉(zhuǎn)開腹,后因胰瘺母嬰死亡,2例因并發(fā)多器官功能衰竭母嬰死亡。內(nèi)鏡組孕婦及胎兒病死率明顯低于保守組(均P0.05),此外,兩組治療3d后的各項實驗室指標(biāo)改善情況,內(nèi)鏡組均優(yōu)于保守組(均P0.05)。結(jié)論:妊娠合并ABP患者早期內(nèi)鏡介入治療安全有效。
[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.
【作者單位】： 南華大學(xué)附屬南華醫(yī)院普通外科;
【基金】：湖南省高�？蒲谢鹳Y助項目(12C0353)
【分類號】：R714.255

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