妊娠合并胰腺炎的临床诊断与治疗

Management of pregnancy-associated pancreatitis:a 7-year single center experience

目的探讨妊娠合并胰腺炎的临床诊断与治疗特点。方法回顾性分析16例(18次)妊娠合并胰腺炎患者的临床资料。结果中期妊娠3例次,晚期妊娠15例次。重症急性胰腺炎5例。合并高脂血症6例,胆道疾病1例。血或/和尿淀粉酶升高者14例次(77.8%,14/18)。B超提示胰腺炎12例次(66.7%)。16例患者给予保守治疗,其中1例转手术清创引流。13例终止妊娠。产妇无死亡,胎儿死亡3例(18.8%)。结论妊娠期合并胰腺炎以中晚期妊娠为主。高脂血症是主要病因。以保守治疗及保证孕妇安全为首选;及时终止妊娠,母婴分科协作抢救有利于提高疗效。

Objective To investigate the diagnosis and treatment of pregnancy-associated pancreatitis（PAP）.Methods A retrospective review of medical records of pregnant women suffered from PAP admitted to Xiangya Hospital between 2002 and 2009.Results Sixteen patients presenting with 18 episodes of acute pancreatitis were identified.Most attacks occurred in the third trimester（15/18）.Five patients were classified as SAP by APACHE II system.Six patients had hypertriglyceridemia,1 patient caused by gall stone,the others had ＂undetermined＂ etiologies.Elevating of amylase was appeared in 14 patients（77.8%,14/18）.B type ultrasonography（BUS） was taken as the most effective method for diagnosis of pancreatitis,the accuracy diagnastic rate was 66.7% of BUS in this study.All the patients were accepted conservative treatment after admission.Operation was performed in one patient.Pregnancy was terminated in 13 patients.Three fetal were loss（18.8%） and there were no maternal death occurred.Conclusions Pancreatitis attacks pregnancy women in second and third trimester mostly.Hypertriglyceridemia was the frequency cause of pregnancy-associated pancreatitis in this group.Conservative treatment was the first choice of treatment.The safety of maternal should have to be considerated firstly during treatment.Terminating pregnancy in the proper time,as well as treating maternal and fetal by cooperation of doctors of separate department may help increase the prognosis of this disease.