B超引导内镜下治疗在妊娠期急性重症胰腺炎早期治疗中的价值

The value of early B ultrasound guided endoscopic therapy in the treatment of severe acute pancreatitis during pregnancy

目的探讨早期B超引导内镜下十二指肠乳头括约肌切开术(EST)和鼻胆管引流(ENBD)术在妊娠期急性重症胰腺炎治疗中的价值。方法将38例妊娠期急性重症胰腺炎患者按随机法分为内镜治疗组13例及对照组25例。内镜治疗组在入院后72 h内行B超引导内镜下EST和ENBD术以及多学科综合治疗,对照组仅行多学科综合治疗。比较两组患者治疗前和治疗7 d后APACHEⅡ(急性生理和慢性健康评价指标Ⅱ)评分、谷草转氨酶、总胆红素和C反应蛋白差异,以及腹痛缓解时间、肠功能恢复时间、30 d内胰腺假性囊肿、胰腺脓肿以及全身并发症发生率和终止妊娠率、住院天数的差异。结果两组治疗前APACHEⅡ评分、谷草转氨酶、总胆红素和C反应蛋白差异无显著性(P>0.05),内镜治疗组7 d后APACHEⅡ评分(6.68±1.38)分,谷草转氨酶(128.38±60.93)u/L,总胆红素(44.62±15.59)mmol/L,C反应蛋白(84.08±26.06)mmol/L;腹痛缓解时间(9.57±2.09)d,肠功能恢复时间(12.74±2.52)d。30 d内胰腺假性囊肿、胰腺脓肿和全身并发症发生率分别30.8%、7.7%和21.1%;终止妊娠率69.2%和住院天数(38.32±8.56)d,比较对照组明显下降,差异有显著性(P<0.05)。结论妊娠期急性重症胰腺炎患者给予早期72 h以内B超引导内镜下十二指肠乳头括约肌切开术(EST)和鼻胆管引流(ENBD)术安全、可行,治疗效果明显。

【Objective】To investigate the value of early B-guided endoscopic duodenal sphincterotomy（EST）and nasal biliary drainage（ENBD） during pregnancy in the treatment of severe acute pancreatitis. 【Methods】38cases of pregnancy patients with severe acute pancreatitis were randomly divided into endoscopic treatment group（13 cases） and control group（25 cases）. Endoscopic treatment group within 72 h after admission accepted B ultrasound-guided endoscopic surgery EST and ENBD and multidisciplinary treatment, the control group received only multidisciplinary treatment. The two groups of patients were compared before treatment and 7 days APACHE Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ） score, aspartate aminotransferase, total bilirubin, C-reactive protein differences, and abdominal pain time, intestinal function recovery time, 30 days of the pancreas pseudocyst,pancreatic abscess and systemic complication rates, terminate pregnancy, the number of days hospitalized difference.【Results】Before treatment APACHEⅡ score, aspartate aminotransferase, total bilirubin, C-reactive protein were no significant different（P〉0.05）, APACHEⅡ score（6.68±1.38） points, aspartate aminotransferase（128.38 ±60.93） u/L,total bilirubin（44.62 ±15.59） mmol/L, C-reactive protein（84.08 ±26.06） mmol/L; pain relief time（9.57 ±2.09） days,the intestinal function recovery time（12.74±2.52） days, 30 days, pancreatic pseudocyst, pancreatic abscess, systemic complication rates endoscopic treatment group after seven days were 30.8%, 7.7%, 21.1%; terminate the pregnancy rate 69.2%, inpatient days（38.32±8.56） days, decreased significantly compared with control group, there was significant difference（P〈0.05）.【Conclusion】Patients with severe acute pancreatitis during pregnancy who are given early within less than 72 h B ultrasound-guided endoscopic sphincterotomy（EST） and nasal biliary drainage（ENBD）surgery is safe and feasible, the treatment effect is obvious.