妊娠晚期合并急性胰腺炎22例临床分析

Late Pregnancy Complicated with Acute Pancreatitis-22 Cases Analysis

目的:探讨妊娠晚期合并急性胰腺炎的临床特征和诊治策略。方法:对我院近10年来妊娠晚期合并急性重症胰腺炎9例和急性轻症胰腺炎13例患者的临床资料进行回顾性分析。结果:22例患者腹痛、恶心呕吐发生率分别为90.9%及68.2%,此外,异常的血尿淀粉酶、血清脂肪酶、血糖、血钙浓度及甘油三酯发生率也较高;59.1%的孕妇有胆结石。12例(54.5%)患者急诊因胎儿窘迫行剖宫产终止妊娠,10例(45.5%)患者入院后经治疗好转延长孕周至足月后终止妊娠。新生儿Apgar评分结果15例正常,4例轻度窒息,3例重度窒息。急性重症胰腺炎与轻症患者的新生儿窒息率相比,差异有高度统计学意义(x2=9.314,P<0.05)。结论:妊娠晚期合并急性胰腺炎患者以持续性上腹痛及中上腹部固定压痛为主,血尿淀粉酶和脂肪酶升高以及B超检查异常发现等有重要的诊断价值。应在接受内科综合治疗的同时,估计孕周以及胎儿情况等适时终止妊娠,终止妊娠的方法首选剖宫产术,术中根据具体情况可作相应的外科处理。

Objective：To assess the clinical features,diagnosis and treatment of acute pancreatitis in late pregnancy.Methods：Women with acute pancreatitis in late pregnancy which including 9 cases of severe acute pancreatitis and 13 cases of mild acute pancreatitis in our hospital from Jan 2000 to Jun 2009 were retrospectively reviewed.Results：Prevalence of stomachache,nausea and vomiting was 90.9% and 68.2%,respectively in 22 patients.In additionally,abnormalities of serum/urinary amylase,serum lipase,serum sugar,serum calcium and triglyceride were also present.Of the patients 59.1% had cholecystolithiasis,12 patients（54.5%）received caesarean section in emergency because of fetal distress.10 patients（45.5%）had term pregnancy after treatment.Apgar score of the new born was as following：15 cases were normal,4 cases were mild asphyxia,and 3 cases were severe asphyxia.There was statistic difference in newborn asphyxia between acute severe pancreatitis and mild patients（x2 =9.314,P=0.009）.Conclusions：Clinical manifestation of acute pancreatitis in late pregnancy is persistent epigastria pain with fixed tenderness on upper-mid-abdomen.Elevation of serum/urine amylase or serum lipase and some specific signs in ultrasound are important for diagnosis.According to the pregnancy age and the fetal situation,conservative therapy and timely termination of pregnancy should employ in late pregnancy with acute pancreatitis,and the best way to terminate pregnancy is caesarean section.What＇s more,surgical measurements should be performed on basis of the current finding.