妊娠期急性胰腺炎6例分析

妊娠期合并急性胰腺炎少见，2004～2006年我院收治的急性胰腺炎108例中有6例为妊娠期急性胰腺炎。现分析如下。     

妊娠期急性胰腺炎20例

目的:探讨妊娠期急性胰腺炎(acute pancreatitis in pregnancy,APIP)临床特征及治疗经验.方法:回顾性分析武汉大学人民医院于2004-04/2011-01收治20例APIP患者的临床资料.结果:20例APIP患者中,2例发病于孕中期,17例发病于孕晚期,1例发病于分娩后.3例(15%)行急诊剖宫术加坏死胰腺清除、胰腺引流.11例(55%,孕期均>33wk)行剖宫产分娩.5例(25%)病情稳定后出院.孕妇治愈19例(95%),死亡1例(5%),死因为多器官功能障碍综合征.终止妊娠14例,继续妊娠5例,胎儿死亡共2例(10%),均为入院时胎死宫内;新生儿无死亡,未见畸形.结论:妊娠中晚期容易诱发急性胰腺炎.治疗上以积极非手术治疗为主,遵循个体化治疗原则,适时终止妊娠(剖宫术为首选)有利于母婴的安全.     

妊娠期急性胰腺炎的临床分析

妊娠并发急性胰腺炎并不常见 ,国外妊娠人群中的发病率约为 1/ 10 0 0～ 1/ 5 0 0 0 [1] 。国内文献对该病也有报道[2 ,3] ,但均着重于对病例本身的描述。本文通过设立对照组 ,回顾性研究国人妊娠期急性胰腺炎发生的相关因素及临床表现。资料与方法妊娠组 :1988年 1月至 1999年 12月收住本院的所有妊娠急性胰腺炎患者。对照组 :同期收住本院的所有同年龄组非妊娠女性急性胰腺炎患者。急性胰腺炎的诊断标准 :突然发生的上腹部疼痛 ,血清淀粉酶和 (或 )尿淀粉酶水平为正常上限 4倍以上。实验室检查 :所有患者均作血、尿、粪常规 ,血、尿淀粉酶…     

重症急性胰腺炎72例治疗体会

重症急性胰腺炎(SAP)起病急骤,病死率高,治疗方法多样。我院1996～2004年共收治SAP72例,现就其治疗体会报告如下。     

用循证医学的原理评价急性胰腺炎的预后和治疗

尽管有大量的临床研究探讨急性胰腺炎的早期预后和治疗,但很少进行荟萃分析（meta-analysis）,导致临床评估指标偏倚较大,难以得到普遍认同的早期预后指标和治疗手段,致使急性胰腺炎死亡率仍维持在5％～10％。 本文从循证医学（evidence-based medicine）的角度评价不同的预后方法和治疗措施在急性胰腺炎中的应用,以便寻求规律,得到可靠的结论。所引用的文献均来自于Medline数据库,采用的文章内容主要涉及急性胰腺炎的预后和治疗。     

急性胰腺炎并发症的治疗

急性胰腺炎并发症的治疗山东省千佛山医院（２５００１４）沙建梓急性出血坏死型胰腺炎（ＡＮＰ）的并发症临床多见，近年来对其治疗进展极快，现分述如下。１局部并发症１．１假性囊肿多发生于起病３～４周，胰尾部多见，如囊肿直径＜４ｃｍ、无出血感染，经一般内科治疗...     

重症急性胰腺炎54例治疗体会

1992～2002年，我们收治重症急性胰腺炎(SAP)患者54例。现将其治疗体会总结如下。     

重症急性胰腺炎的综合治疗探讨

重症急性胰腺炎(severe acute pancreatitis,SAP)发病凶猛,病死率高。本文报告我院1995年1月～2002年8月收治88例SAP的治疗情况,以探讨合理的SAP治疗方案。     

经内镜微创治疗急性胰腺炎临床探讨

目的 探讨内镜治疗胆源性急性胰腺炎(BAP)的方法学及疗效。方法 依据入选标准，选择BAP病人24例，在内科综合治疗48～72h无效时行内镜治疗。结果 15例内镜下见乳头部充血、水肿，3例结石嵌顿，2例蛔虫嵌顿，ERCP插管成功22例，其中10例单行ENBD，12例行EST，共取出蛔虫2例，结石7例。术后2～4h诉腹痛减轻者9例，血压上升转平稳者3例，2～4d内腹部体征均有明显好转，导管留置4～7d。除1例形成假性囊肿外，其余均在术后4～28d好转出院。结论 内镜治疗BAP可解除胆道梗阻，达到外科引流效果，是BAP治疗的重要手段之一。     

前列腺素E1治疗急性胰腺炎32例临床观察

近年来的研究表明，胰腺血液循环障碍可诱发急性胰腺炎(AP)和促使水肿型胰腺炎发展成出血坏死型胰腺炎，而维持正常的胰腺血液供应可有效改善AP的预后。自1999年以来．我院应用前列腺素E1(PGE1)治疗AP32例，效果满意，现告如下。     

Evidence for early oxidative stress in acute pancreatitis

Summary Pancreatic oxidative stress with depletion of pancreatic glutathione is an early feature in all tested models of acute pancreatitis, and sooner or later the problem extends to the lung, irrespective of disease severity, whether toward spontaneous recovery or death from multisystem organ failure. We, therefore, sought evidence of oxidative stress in the human disease by analyzing admission blood samples. We found it from high concentrations of oxidatively altered linoleic acid in serum and vitamin C in plasma (p<0.001 vs controls or a group of other acute abdominal crises where the proportion of patients with admission Apache II scores <or> 8 was similar). These changes were accompanied by subnormal levels of ascorbic acid in plasma (p<0.001); selenium (p<0.001), β-carotene (p<0.001), and α-tocopherol in serum (p=0.005 for its molar ratio to cholesterol). Paradoxically, the plasma concentration ofS-adenosylmethionine was elevated (p=0.02), suggesting that this proximate bioactive metabolite of the essential amino acid had backtracked because its intracellular metabolism down the methionine trans-sulfuration pathway toward glutathione synthesis was disrupted. The aberrations transcended putative etiological factor, duration of symptoms, or disease severity. We conclude: (1) that oxidative stress has pervaded the vascular compartment by the time of admission in patients with acute pancreatitis, and, (2) that blood micronutrient antioxidant profiles at this stage are consistent not only with compromised intracellular capacity to synthesize/refurbish glutathione, but also vulnerability of intra- and extracellular lipid targets.     

Severe acute pancreatitis and pregnancy.

For most patients with pregnancy-associated pancreatitis there is little maternal survival threat and only occasionally are there foetal deaths. We describe 4 young women with pregnancy-associated severe acute pancreatitis who each had gallstones. Their ages were 17, 18, 20 and 24 years. Each was a tertiary referral to our unit in Glasgow and each pursued a life-threatening course with hospital stays ranging from 37 to 90 days. One patient required pancreatic necrosectomy for infected necrosis, another had percutaneous management of a pancreatic abscess and 2 had cystogastrostomy as treatment for pancreatic pseudocyst. All underwent early endoscopic sphincterotomy and later cholecystectomy. It is important to be aware that pregnancy-associated acute pancreatitis may be severe, posing a survival threat even in the youngest patients. Gallstones, as we reported almost 20 years ago, are the most common aetiological factor in such patients.     

Evidence for a role of mitogen-activated protein kinases in the treatment of experimental acute pancreatitis

Acute pancreatitis(AP) is an inflammatory disease characterized by acute inflammation and necrosis of the pancreatic parenchyma. AP is often associated with organ failure, sepsis, and high mortality. The pathogenesis of AP is still not well understood. In recent years several papers have highlighted the cellular and molecular events of acute pancreatitis. Pancreatitis is initiated by activation of digestive enzymes within the acinar cells that are involved in autodigestion of the gland, followed by a massive infiltration of neutrophils and macrophages and release of inflammatory mediators, responsible for the local and systemic inflammatory response. The hallmark of AP is parenchymal cell necrosis that represents the cause of the high morbidity and mortality, so that new potential therapeutic approaches are indispensable for the treatment of patients at high risk of complications. However, not all factors that determine the onset and course of the disease have been explained. Aim of this article is to review the role of mitogen-activated protein kinases in pathogenesis of acute pancreatitis.     

妊娠并发急性出血坏死型胰腺炎的诊治

急性胰腺炎发病率逐年增多 ,但在妇女妊娠期间 ,发生急性出血坏死型胰腺炎极为少见。现将笔者诊治 2例报道如下 :一、临床资料例 1,女性 ,2 4岁 ,孕 2 1周。因中上腹持续性疼痛呈阵发性加剧 1天伴恶心呕吐 ,于 2 0 0 0年 5月 5日入院。查体 :Ｔ37 7℃ ,Ｐ110次 /分 ,Ｒ2 0次 /分 ,Ｂｐ17/ 12ｋＰａ ,神志清 ,痛苦面容 ,皮肤粘膜未见黄染及瘀点瘀斑 ,心肺无异常 ,中上腹压痛明显 ,轻度肌紧张 ,反跳痛阳性 ,下腹部膨隆 ,宫底脐下 2ｃｍ ,肝脾肋下未触及 ,移动性浊音可疑 ,肠鸣音减弱 ,双下肢无浮肿。辅助检查 :血常规ＷＢＣ18 6 4× 10 9/Ｌ ,…     

急性胰腺炎的内镜下介入治疗

急性胰腺炎内镜治疗的作用仍有争议 ,在 2 0世纪 80年代中期前对于急性胰腺炎的治疗主要为药物、支持、外科手术等治疗 ,内镜下逆行胰胆管造影及十二指肠乳头切开(ERCP EST)被大家认为急性胰腺的是禁忌证。直到近年较多研究证明了内镜介入治疗对于急性胆源性胰腺炎的优点 ,因为急性胆源性胰腺炎 (acutebiliary pancreatitis ,ABP)在胰腺炎占有较大的比例。并且目前逆行胰胆管造影后行十二指肠乳头肌切开治疗严重的胆源性胰腺炎 ,已经在临床上得到了较普遍应用。特别是早期内镜下十二指肠乳头切开引流或取石 (发病 72h内 )对于伴有胆道…     

Evidence for an inherited predisposition to alcoholic pancreatitis

To investigate the role of heredity in alcoholic pancreatitis, an HLA typing study has been performed. Patients with alcoholic pancreatitis exhibited an increased frequency of HLA Bw 39 when compared with the general population [13.6% vs 3.3%, P (corrected) <0.02; relative risk 4.7]. Alcoholics without pancreatitis did not differ from the general population with respect to HLA status, indicating that the increased incidence of HLA Bw 39 was related to alcoholic pancreatitis rather than to alcoholism itself. Thus, this study has provided evidence for a genetic predisposition to alcoholic pancreatitis.The work was supported in part by the National Health and Medical Research Council of Australia, The Australian Associated Brewers, and the Clive and Vera Ramaciotti Foundations.