26例妊娠合并急性胰腺炎患者的临床分析

Clinical Analysis on Acute Pancreatitis in 26 Cases of Pregnancy

目的探讨妊娠合并急性胰腺炎（acute pancreatitis，AP）的发病机制与治疗策略。方法以26例进行常规孕检的健康妊娠妇女做对照组，回顾性分析了笔者医院26例妊娠合并AP患者（设为治疗组）的发病特点、辅助检查、治疗方法及结局。结果（1）22例轻症患者均采用保守治疗，有9例因治疗效果不满意或家属要求而终止妊娠（其中5例妊娠12～34周患者实施了引产，4例妊娠33—37周患者实施了剖宫产），13例病情稳定并继续妊娠直至出院。（2）4例重症患者中，1例行剖宫产；1例行剖宫产术后予以胆囊切除＋胰腺坏死组织清创引流＋空肠造瘘术；1例胎死宫内、引产后行胆总管内取石、胰腺及腹腔引流术；1例高脂血症性胰腺炎患者予以引产和血液滤过。所有26例患者均治愈。结论对于妊娠合并轻症胰腺炎的患者尽量选择保守治疗，但病情加重时，可以终止妊娠。对于妊娠合并重症急性胰腺炎（severe acute pancreatitis，SAP）的患者除保守治疗外，需尽早终止妊娠。胆源性胰腺炎患者应酌情予以胆结石清除及引流术。高脂血症性胰腺炎应配合降脂治疗，必要时予以血液滤过。

Objective To investigate the pathogenesis and treatment strategies of acute pancreatitis （AP） in pregnancy. Methods Twenty - six health women and twenty - six patients complicated with acute panereatitis in pregnancy were considered as the control group and treated group respectively. We analyzed retrospectively the characteristics, auxiliary examination, treatment and clinical outcomes of 26 cases of patients with AP in pregnancy. Results （1） Twenty - two patients with mild acute pancreatitis （MAP） were given conservative treatment. Nine of them selected automatic termination of pregnancy because of the unsatisfied therapeutic efficacy or their requirements. Induced labor was conducted in 5 cases during 12 -34 weeks while cesarean section in 4 cases during 33 -37 weeks. （2）Among 4 patients with severe acute pancreatitis （SAP） ,2 cases underwent cesarean section while one of them received choleeysteetomy,debridement and drainage of pancreatic necrosis and percutaneous endoscopic jejunostomy then. Due to fetal death, 1 case received ERCP sphincteroto- my and extraction of bile duct stones with pancreatic and intraperitoneal drainage after induced labor. The remaining one with hyperlipidem- ic panereatitis was given induced labor and hemodialysis. All twenty - six patients were cured finally. Conclusion The first choice of MAP in pregnancy is conventional therapy. However, we should terminate pregnant immediately when the situation deteriorates. Apart from conventional therapy, we need to end pregnancy as early as possible for patients with SAP. Gallstone clearance and drainage is supposed to be considered for biliary pancreatitis. Lipid - lowering treatment should be applied to hyperlipidemic pancreatitis or given to hemofiltration sometimes. It＇s of great value for diagnosis of AP in pregnancy to dynamically observe urine and blood amylase, B - ultrasound and CT scan.