妊娠合并急性胰腺炎16例临床诊治分析

Retrospective analysis of 16 patients with acute pancreatitis in pregnancy and optimization of diagnosis and treatment

目的:分析妊娠合并急性胰腺炎的临床特点,探讨个体化诊治方案。方法:回顾我院2005年10月~2017年10月收治的16例妊娠合并急性胰腺炎患者的临床资料及诊治过程。结果:16例患者中轻型11例,重型5例。轻型患者给予禁食、胃肠减压、抑制胰液分泌等内科保守治疗,必要时应用硫酸镁抑制宫缩,均痊愈出院;重型在此基础上给予急诊剖宫产、血浆置换、肠内营养等治疗后好转出院。分娩结局:11例轻型患者4例足月产,7例剖宫产,新生儿均存活。5例重型患者均急诊行剖宫产,1例双胎胎死宫内,3例早产儿均存活,1例晚期流产儿未存活。结论:妊娠期急性胰腺炎发病急、快、重,应增强孕期管理和高危人群的筛查。诊治中应根据病因、病情的严重程度及胎儿孕周大小,充分评估母婴安全,制定个体化的治疗方案。

Objective：To investigate the clinic features and recommend optimized treatment for pregnant women complicated with acute pancreatitis.Methods：A retrospective study was conducted on clinical data of 16 pregnancy complication with acute pancreatitis in our hospital from October 2005 to October 2017.Results：Of the 16 cases,11 cases had mild acute pancreatitis（MAP）,5 cases had severe acute pancreatitis（SAP）.The 11 MAP cases got recovery after some conservative medical treatment,such as fasting,gastrointestinal decompression,inhibition of pancreatic secretion,and admission of magnesium sulfate to suppress uterine contraction when necessary.The 5 SAP cases got recovery after above treatment plus caesarean delivery,plasmapheresis and enteral nutrition.Delivery outcomes：for the 11 MAP cases,all the 11 neonates survived in good condition with 7 cases by Caesarean and 4 cases by vaginal.All the 5 SAP cases were delivered by Caesarean with 3 survived infants,1 intrauterine death and 1 late abortion death.Conclusion：Acute pancreatitis in pregnancy（APIP）is an extremely dangerous clinical complication.Early prenatal diagnosis and screening are the key to reduce adverse pregnancy.Individual therapeutic program based on etiology and severity of the disease,as well as the gestational stage,will be helpful.