妊娠合并急性胰腺炎的临床诊治分析

Clinical analysis of diagnosis and treatment of acute pancreatitis in pregnancy

目的探讨妊娠合并急性胰腺炎（acute pancreatitis in pregnancy，APIP）的病因、发病机制、临床特点及防治措施。方法对四川大学华西医院自1996年1月至2006年12月间收治的共63例APIP病人的临床资料进行回顾性分析。结果该组63例中，属轻型急性胰腺炎（milda cute pancreatitis，MAP）者43例（68．25％），重症急性胰腺炎（severe acute pancreatitis，SAP）者20例（31．75％）；有胆囊炎合并胆囊结石病史者37例（58．73％），高脂血症者19例（30．16％）。采用非手术治疗49例（77．78％），手术治疗14例（22．22％），孕妇治愈58例（92．06％），死亡5例（7．94％），死因多为MSOF及ARDS；终止妊娠14例，49例继续妊娠；胎儿共死亡14例（21．21%）；漏诊、误诊5例（7．94％）。结论APIP的发生与胆结石和高脂血症有关，并于妊娠中晚期发病率高；其临床表现复杂，易误诊，对孕妇及胎儿威胁极大；把握该疾病的特点，提高对APIP的认识和警惕性，及时准确的诊断与“个体化”的治疗原则，适时终止妊娠，可以提高其治愈率，降低母婴死亡率。

Objective To explore the etiology, mechanism, clinical features, diagnosis, therapy and prevention of acute pancreatitis in pregnancy（APIP）. Methods The clinical data of 63 cases of APIP treated in our hospital from January 1996 to December 2006 were retrospectively analyzed. Results Among the 63 cases of APIP, there were 43 （68. 25%） cases of mild acute pancreatitis （MAP） and 20 （31.75%）cases of severe acute panereatitis （SAP）. Thirty-seven （58.73%） patients had gallstone or chronic cholecystitis and 19 （30.16%） had hyperlipidemia before the onset of APIP. Forty-nine （77.78%） patients received conservative therapy and 14 （22.22%） ,surgical operations. A total of 58 （92.06%） patients recovered. The mortality during pregnancy was 7.94% （5 cases） for the pregnant women, and 21.21% （14 cases） for the fetuses. In most of these cases, the major causes for death were MSOF and ARDS. Fourteen cases received termination of pregnancy and 49 continued their pregnancy. There were 5 cases （7.94%） of missed diagnosis,and misdiagnosis. Conclusion The occurrence of APIP is mainly related to gallstone and hyperlipidemia and it is prone to occur during the midterm and late stage of pregnancy. Since the clinical presentation of APIP is complex, misdiagnosis is likely and it threatens the lives of mother and fetus seriously. For the purpose of increasing the cur ative rate and reducing the mortality of APIP, taking hold of its features, raising the vigilance of dis cerning APIP, making an early correct diagnosis and proper individualized therapy principles, and the timely termination of pregnancy are of great importance.