摘要
目的观察妊娠合并急性结石性胆囊炎的发病特点及中西医结合综合方法的治疗效果。方法收集天津市中西医结合医院于2020年3月—2025年2月收治的47例、共计发作54例次的妊娠合并急性结石性胆囊炎病例,对采用的中西医结合综合治疗方法疗效进行分析。结果经中西医结合保守治疗35例次占全组64.8%,其中经皮胆囊穿刺引流术8例,妊娠中期2例,妊娠晚期6例。腹腔镜胆囊切除术/胆管探查取石术及经十二指镜胆管取石共19例,占全组35.2%。行胆囊切除术/胆管探查取石术18例,妊娠早期2例,均同时行引产术,中期7例,2例引产;晚期9例,于剖宫产术后进行或与剖宫产手术同时进行。经十二指肠镜胆管取石1例,于妊娠早期,同时行引产术。全组共2例宫内死胎,发生于重型急性胰腺炎病例。结论妊娠期合并急性结石性胆囊炎多采用非手术治疗,尤其是妊娠早期和晚期。中西医结合综合治疗在西医治疗基础上中医辩证施治,有利于急性胆囊炎的缓解。对妊娠中晚期孕妇合并严重急性胆囊炎者行经皮胆囊穿刺引流术,能有效把高风险的妊娠期急诊手术转变成择期手术。
Objective To observe the characteristics of the attack of acute calculous cholecystitis during pregnancy and the therapeutic effect of the comprehensive treatment method combining traditional Chinese and Western medicine.Methods A total of 47 cases(54 episodes)of acute calculous cholecystitis during pregnancy admitted to Tianjin Hospital of Integrated Traditional Chinese and Western Medicine from March 2020 to February 2025 were collected and summarized,and the efficacy of the comprehensive treatment method combining traditional Chinese and Western medicine was analyzed.Results Among the 54 episodes,35 cases(64.8%)were treated conservatively with a combination of traditional Chinese and Western medicine,including 8 cases of percutaneous transhepatic gallbladder drainage(PTGD),2 were cases in the second trimester and 6 cases were in the third trimester.Laparoscopic cholecystectomy(LC)/common bile duct exploration and stone removal and endoscopic retrograde cholangiopancreatography(ERCP)for stone removal were performed in 19 cases(35.2%),including 18 cases of cholecystectomy/common bile duct exploration and stone removal,2 cases were in the first trimester,both of which underwent induced abortion simultaneously,7 cases were in the second trimester,2 of which underwent induced abortion,and 9 cases were in the third trimester,which were performed after cesarean section or simultaneously with cesarean section.One case of ERCP for stone removal was performed in the first trimester,and induced abortion was also performed simultaneously.There were 2 cases of intrauterine fetal death in the entire group,both suffered from severe acute pancreatitis(SAP).Conclusion Non-surgical treatment is mostly adopted for acute calculous cholecystitis during pregnancy,especially in the first and third trimesters.The comprehensive treatment method combining traditional Chinese and Western medicine,which is based on Western medical treatment and supplemented by traditional Chinese medicine treatment according to syndrome differentiation,is beneficial for the relief of acute cholecystitis.For pregnant women in the second and third trimesters with severe acute cholecystitis,PTGD can effectively transform high-risk emergency surgery during pregnancy into elective operation.
作者
毛雪梅
崔志刚
魏明
MAO Xue-mei;CUI Zhi-gang;WEI Ming(Obstetrics and Gynecology Department of Nankai Hospital,Tianjin 300100,China;Emergency Department of Nankai Hospital,Tianjin 300100,China)
出处
《继续医学教育》
2025年第7期154-157,177,共5页
Continuing Medical Education
基金
天津市教委科研计划项目(2024KJ247)
河北中医药管理局科研计划项目(T2025038)。
关键词
妊娠
急性胆囊炎
胆囊结石
中西医结合治疗
经皮胆囊穿刺引流术
pregnancy
acute cholecystitis
gallbladder stones
integrated traditional chinese and western medicine treatment
percutaneous transhepatic gallbladder drainage
