妊娠期急性胰腺炎20例

Acute pancreatitis in pregnancy: an analysis of 20 cases

目的:探讨妊娠期急性胰腺炎(acute pancreatitis in pregnancy,APIP)临床特征及治疗经验.方法:回顾性分析武汉大学人民医院于2004-04/2011-01收治20例APIP患者的临床资料.结果:20例APIP患者中,2例发病于孕中期,17例发病于孕晚期,1例发病于分娩后.3例(15%)行急诊剖宫术加坏死胰腺清除、胰腺引流.11例(55%,孕期均>33wk)行剖宫产分娩.5例(25%)病情稳定后出院.孕妇治愈19例(95%),死亡1例(5%),死因为多器官功能障碍综合征.终止妊娠14例,继续妊娠5例,胎儿死亡共2例(10%),均为入院时胎死宫内;新生儿无死亡,未见畸形.结论:妊娠中晚期容易诱发急性胰腺炎.治疗上以积极非手术治疗为主,遵循个体化治疗原则,适时终止妊娠(剖宫术为首选)有利于母婴的安全.

AIM： To explore the clinical features and management of acute pancreatitis in pregnancy （APIP）.METHODS： The clinical data for 20 patients with APIP who were treated at the People’s Hospital of Wuhan University from April 2004 to January 2011 were retrospectively reviewed.RESULTS： Of 20 patients with APIP, 2 were diagnosed in the second trimester, 17 in the third trimester, and 1 in the postpartum period; 3 （15%） received emergency operation, in which clearance of necrotic tissue in the pancreas and abdominal cavity drainage were performed after uterineincision delivery; 11 （55%, all 33 weeks of preg-nancy） received uterine-incision delivery; 5 （25%） were discharged in a stable condition; 19 （95%） recovered, and 1 （5%） died of multiple organ dysfunction syndrome （MODS）; 14 （70%） terminated pregnancy, and 5 （25%） continued the pregnancy; 2 had pre-admission fetal death in utero.CONCLUSION： APIP often occurs in the middle and late pregnancy. Conservative medical therapy is usually recommended f irst for APIP. Individualized therapy and termination of preg, nancy may be benef icial to maternal and neonatal safety in some cases.