妊娠合并急性胰腺炎误诊三例探析

Misdiagnosis Analysis of 3 Pregnancy Women Complicated with Acute Pancreatitis

目的探讨妊娠合并急性胰腺炎的临床特点及误诊原因、防范措施。方法对2018年1月-2020年5月收治的曾误诊的妊娠合并急性胰腺炎3例的临床资料进行回顾性分析。结果3例孕妇分别因上腹疼痛1 d,加重5 h;急性下腹痛6 h;右上腹和右下腹疼痛伴呕吐(24 h内呕吐6次)1 d就诊。初期误诊为胎盘早剥、子宫破裂和HELLP综合征并胎儿窘迫,均急诊行剖宫产术。术后皆出现腹部疼痛,后根据临床表现及相关检查结果确诊为急性胰腺炎。3例均转入外科,予相应治疗后病情好转出院。结论妊娠合并急性胰腺炎是一种少见但严重疾病,临床表现与产科常见急腹症相似,易误诊。产科医生应提高对此类疾病认识,认真进行鉴别诊断,当临床遇及类似本文患者时要详细询问病史,及时行相关检查,以减少或避免妊娠合并急性胰腺炎误诊误治。

Objective To investigate clinical characteristics,misdiagnosed causes and preventive measures of acute pancreatitis in pregnancy women.Methods Clinical data of 3 pregnancy women complicated with acute pancreatitis who were misdiagnosed during January 2018 and May 2020 was retrospectively analyzed.Results Three pregnant women presented with epigastric pain for 1 d and aggravation for 5 h,acute lower abdominal pain for 6 h and pain in the right upper abdomen and right lower abdomen accompanied by vomiting(6 times within 24 h)for 1 d respectively.The 3 women were initially misdiagnosed as having placental abruption,uterine rupture and HELLP syndrome combined with fetal distress,and then emergency cesarean section was performed.All patients had abdominal pain after surgery,and then acute pancreatitis was confirmed according to clinical manifestations and related examination results.All the three women were transferred to surgery department,and all patients were discharged after patients'conditions had been improved by corresponding treatment.Conclusion Pregnancy women complicated with acute pancreatitis is rare but serious,and the clinical manifestations are similar to those of common acute abdomen in obstetrics department,therefore,it is more likely to be misdiagnosed.Obstetricians should enhance their awareness of such diseases and carefully differential diagnosis.Patients with similar clinical characteristics should be ask medical history carefully,carry out relevant examinations in order to reduce or avoid misdiagnosis of acute pancreatitis in pregnancy women.