妊娠合并急性胰腺炎19例回顾性分析

A retrospective study of 19 cases with acute pancreatitis in pregnancy.

目的探讨妊娠合并急性胰腺炎的临床特征和治疗策略。方法回顾性分析2007年11月至2010年11月上海市第六人民医院妇产科收治的19例妊娠合并急性胰腺炎的临床资料,包括患者的临床表现、高危因素、诊断、治疗及预后。结果 19例患者中,轻型急性胰腺炎11例(57.9%),重型急性胰腺炎8例(42.1%)。致病危险因素主要为胆囊和(或)胆管结石(4例)及高脂血症(4例)。19例(100%)突发上腹疼痛,18例(94.5%)伴恶心呕吐。4例(21.1%)发热,8例(42.1%)全腹痛、腹胀,8例(42.1%)呼吸循环功能不稳定均预示重症急性胰腺炎存在。18例(94.5%)患者血和(或)尿淀粉酶水平升高;5例(26.3%)彩超诊断,8例(42.1%)彩超后行MRI或CT确诊。1例延误诊断。采用保守治疗15例(78.9%)效果较满意;4例(21.1%)外科干预。对重症患者,5例(26.3%)ICU监护,2例(10.5%)外科重症监护病房观察。19例(100%)患者预后好,无孕产妇死亡,早产7例(36.8%);围生儿死亡2例(10.5%)。结论妊娠期急性胰腺炎早期诊断及病情严重性评估非常重要;综合保守治疗效果较满意,重症患者加强监护,尽量延迟外科干预。

Objective To explore features of clinical manifestation, diagnosis and management of acute pancreatitis （AP） in pregnancy. Methods Medical records of 19 patients with AP in pregnancy admitted to the Obstetrics and Gynecology of No. 6 Peopleg Hospital Affiliated to Shanghai Jiao Tong University between Nov. 2007 and Nov. 2010 were studied ret- rospectively. Results Among the 19 patients, mild acute pancreatitis （MAP） occurred in 11 cases （57.9%）, while se- vere acute pancreatitis （SAP） occurred in the rest 8 cases （42. 1% ）. Pathogenic risk factors mainly were gallbladder and/or biliary tract stones （4 cases） and hyperlipidemia（4 cases）. Nineteen （100%） presented with acute abdominal pain, 18 （94. 5% ） with nausea and vomiting. Fever （4 cases, 21.1% ） , abdominal distension （8 cases, 42. 1% ） , and unstable respiratory and circulatory function（8 cases, 42. 1% ）accompanied were strong indications for SAP. Eight- ee, n cases （94. 5% ） had elevation of the plasma and/or urine concentration of amylase. Five cases （26. 3% ） were diag- nosed by color sonography and 8 （42. 1% ） by MRI or CT after color sonography. One case had a delay in diagnosis. Pos- itive conservative treatment was taken in most of the cases （15 cases, 78. 9% ） with a favorable outcome. Five cases （26. 3% ） of critically ill patients were monitored in ICU, and 4 patients underwent surgical interventions. As a result, all of the 19 patients had better prognosis. No maternal death was observed. There were 7 preterm labors and 2 fetal los- ses, accounting for the perinatal mortality of 10. 5%. Conclusion While a pregnant woman suffered acute abdominal pain, early diagnosis and illness severity assessment of AP is very important. Active conservative treatment with intensive care is recommended. Surgical intervention should be performed as late as possible.