摘要
目的:探讨妊娠合并急性胰腺炎的临床特征及治疗结局。方法:回顾性总结上海市交通大学附属第一人民医院2006-01～2009-06和上海市江湾医院2006-01～201106收治的妊娠合并急性胰腺炎患者8例的临床资料,分析其发病诱因、临床特点、实验室指标及妊娠结局。结果:8例均为孕晚期发病,腹痛、腹胀占75%(6例);恶心、呕吐、上腹部压痛、反跳痛占62.5%(5例),肌紧张和肠鸣音减弱占50%(4例),其他还表现为不规则宫缩、发热、胸闷、黄疸、高血压等。实验室指标:血、尿淀粉酶及白细胞计数增高7例;脂肪酶增高5例;高血糖、低血钙4例;乳酸脱氢酶、甘油三酯、胆红素增高3例;总胆固醇、转氨酶增高2例,蛋白尿3例,凝血指标异常1例。5例B超提示胰腺肿胀、胰周积液,其中4例B超提示胆囊炎、胆石症。3例CT提示胰腺肿胀、边缘模糊或胰腺周围高密度影。除予内科治疗外,4例行胰包膜切开引流+腹腔引流术,其中2例同时行胆囊切除+胆总管切开取石术。1例孕28+5周患者症状较轻经保守治疗待产至足月分娩,1例死胎阴道分娩,其余6例均及时剖宫产。死胎1例,新生儿死亡2例,无孕产妇死亡,围生儿死亡率达37.5%。结论:妊娠合并急性胰腺炎多为孕晚期发病,主要发病诱因为胆道结石和高脂血症。临床表现主要为胃肠道征象,实验室指标和影像学检查可协助诊断。早期诊断和多学科配合是改善母儿预后的关键。
Objective： To probe the clinical features, diagnosis and treatment of acute pancreatitls m preg- nancy. Methods： 8 cases of acute pancreatitis in pregnancy in Shanghai Jiangwan Hospital from Jan 2006 to Jun 2011 and the First Hospital of Shanghai Jiao Tong University from Jan 2006 to Jun 2009 were retrospectively reviewed. Results： All cases are in late pregnancy. Prevalence of abdominal pain and abdominal distention was 75~ （6 cases） and prevalence of epigastric pain with rebound and nausea and vomiting was 62.5~ （5 cases） and prevalence of abdominal tenderness and dorhorygmus decreased （4 cases）. In addition, other clinical pre- sentations included unregulated uterine contractions, fever, chest tightness, jaundice and hypertension etc. The experimental data displayed： elevation of blood/urinary amylase and white blood cell count in 7cases, high blood sugar and low blood calcium in 4 cases; elevation of lactin dehydrogenase, triglyceride and bilirubin in 3 cases; elevation of total cholesterol and transaminase in 2 cases; urine protein in 3 cases; abnormalities of thrombosis in 1 case. Abdominal ultrasound showed the tumid pancreas and liquid around the pancreas in 5 cases. Among these cases, there were 3 cases with cholecystitis or cholelithiasis. CT scan showed pancreas swelling and the obscure edge or high density image around the pancreas in 3 cases. Besides medical treatment, four patients were treated with incision and drainage of pancreatic capsule and peritoneal drainage. Among these cases, there were two patients with cholecystectomy and choledocholithotomy. Pregnant outcome： one pregnancy was term delivery after expectant therapy from the 28＋5th weeks＇ gestation, one was spontaneous delivery because of fetal death, and other 6 patients were timely termination by cesarean section. 1 case of fetal death, 2 cases of neonatal death, no pregnant death. Perinatal mortality rate was up to 37.5%. Conclusion： Acute pancreatitis is mainly in late pregnancy, and it is induced mainly by cholelithiasis and hyperlipidaemia. Clinical manifestation of acute pancreatitis in pregnancy shows the symptoms related to gastrointestinal tract. The Laboratory indexes and some specified signs in examination by iconography are helpful for diagnosis. Early diagnosis and interdisci- plinary cooperation is the key to improve the prognosis of pregnancy and neonate.
出处
《黑龙江医药科学》
2012年第5期26-28,共3页
Heilongjiang Medicine and Pharmacy
关键词
急性胰腺炎
妊娠
acute pancreatitis
pregnancy
