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目的探讨妊娠合并急性胰腺炎的临床特征和治疗策略。方法回顾性分析2007年11月至2010年11月上海市第六人民医院妇产科收治的19例妊娠合并急性胰腺炎的临床资料,包括患者的临床表现、高危因素、诊断、治疗及预后。结果 19例患者中,轻型急性胰腺炎11例(57.9%),重型急性胰腺炎8例(42.1%)。致病危险因素主要为胆囊和(或)胆管结石(4例)及高脂血症(4例)。19例(100%)突发上腹疼痛,18例(94.5%)伴恶心呕吐。4例(21.1%)发热,8例(42.1%)全腹痛、腹胀,8例(42.1%)呼吸循环功能不稳定均预示重症急性胰腺炎存在。18例(94.5%)患者血和(或)尿淀粉酶水平升高;5例(26.3%)彩超诊断,8例(42.1%)彩超后行MRI或CT确诊。1例延误诊断。采用保守治疗15例(78.9%)效果较满意;4例(21.1%)外科干预。对重症患者,5例(26.3%)ICU监护,2例(10.5%)外科重症监护病房观察。19例(100%)患者预后好,无孕产妇死亡,早产7例(36.8%);围生儿死亡2例(10.5%)。结论妊娠期急性胰腺炎早期诊断及病情严重性评估非常重要;综合保守治疗效果较满意,重症患者加强监护,尽量延迟外科干预。
Objective To investigate the clinical features and treatment strategies of pregnancy complicated with acute pancreatitis. Methods The clinical data of 19 cases of pregnancy complicated with acute pancreatitis admitted to Department of Obstetrics and Gynecology of the Sixth People ’s Hospital of Shanghai from November 2007 to November 2010 were retrospectively analyzed. The clinical manifestations, risk factors, diagnosis, treatment and prognosis were included. Results Of the 19 patients, there were 11 cases (57.9%) of acute pancreatitis and 8 cases (42.1%) of severe acute pancreatitis. Pathogenic risk factors mainly gallbladder and (or) bile duct stones (4 cases) and hyperlipidemia (4 cases). Nineteen (100%) patients had sudden upper abdominal pain and 18 patients (94.5%) had nausea and vomiting. Four cases (21.1%) had fever, and eight cases (42.1%) had abdominal pain, abdominal distension and 8 cases (42.1%) instability in respiration and circulation all indicated the existence of severe acute pancreatitis. Eighteen patients (94.5%) had elevated blood and / or urinary amylase, 5 (26.3%) were diagnosed by color Doppler ultrasound and 8 (42.1%) were diagnosed by color Doppler ultrasound or CT. 1 case delayed diagnosis. Fifteen patients (78.9%) received satisfactory conservative treatment and four (21.1%) received surgical intervention. For critically ill patients, ICU surveillance was performed in 5 patients (26.3%) and in 2 surgical ICUs in 2 patients (10.5%). Nineteen (100%) patients had a good prognosis, no maternal death, 7 (36.8%) premature births, and 2 perinatal deaths (10.5%). Conclusion Early diagnosis of acute pancreatitis in pregnancy and the evaluation of the severity of the disease are very important. The results of comprehensive conservative treatment are satisfactory. Intensive care is given to critically ill patients and surgical intervention is delayed as soon as possible.