妊娠合并急性胰腺炎的临床特征——附6例报道及文献复习

目的探讨妊娠合并急性胰腺炎AP的病因、临床特点、诊断、治疗及预后。方法将我院6例患者和文献检索的94例患者分为A、B两组,观察患者发病时的孕龄、孕周、诱因、病因、BMI、临床表现、生化指标、治疗结果及预后。结果两组中重症AP(SAP)41例,轻症AP(MAP)59例。其中79例孕中晚期发病,11例产后发病,临床上有不同程度腹痛、恶心、呕吐,部分患者症状不典型,血淀粉酶轻度升高或正常,33例血脂明显升高,48例发病与胆道疾病有关;A组BMI孕后较孕前上升16.90%;两组中29例剖腹探查,71例保守治疗,其中内镜治疗4例,31例孕妇顺产,其中1例为SAP;孕妇死亡率为9%,胎儿24%,孕妇胎儿均死亡6%,死亡原因多为并发MSOF。结论高脂血症、胆道疾病、孕后体重增长过快是发病的主要因素;重症多,死亡率高,妊娠中晚期发病率高,临床表现复杂,易误诊;内科保守治疗为主,适时终止妊娠,外科介入为基本治疗原则;控制体重、血脂和胆道疾病的发作,合理饮食,对预防本病具有重要意义。

Clinical analyses of acute pancreatitis during pregnancy: report of 6 cases and review of the literature

Objective To discuss the pathogenesis, etiology, clinical features, diagnosis, therapy and prognosis of acute pancreatitis(AP) during pregnancy. Methods 6 cases from our hospital and 94 cases from published papers were divided into two groups as group A and group B. The gestational age, gestational week, contributing factors, pathological causes, body mass index (BMI), clinical presentation, biochemical parameters, therapeutic outcome and prognosis were evaluated. Results There were 41 cases of severe acute pancreatitis (SAP) and 59 cases of mild acute pancreatitis (MAP) in all 100 patients. Seventy-nine patients developed AP in the midterm and late stage of pregnancy. Eleven patients developed AP after delivery. Most of the 100 AP patients had epigastric pain of varying degrees, nausea and vomiting. In patients who did not have these typical presentations, the serum amylase level was normal or elevated slightly. Thirty-three patients had hypertriglycemia and 48 patients had biliary diseases before the onset of AP. 16. 90% of the patients in group A had an elevated BMI when compared with their own BMI before pregnancy. In 29 cases, doctors did not have a confirmative diagnosis before celiotomy. Sixty-five patients accepted conservative therapy and 4 patients underwent endoscopic therapy. Of the 59 MAP patients, 30 patients delivered naturally. The mortality during pregnancy was 8% for the pregnant women, and 24% for the fetuses. In 6% cases, both pregnant women and their fetuses died. In most of these cases, the direct cause for death was MSOF. Conclusions Hypertriglycemia, biliary diseases, quick raise of BMI after pregnancy are major causes of AP during pregnancy. The SAP/AP ratio and mortality is higher during pregnancy. The incidence of AP is higher during the midterm and late stage of pregnancy. Since the clinical presentation for AP during pregnancy is complex, misdiagnosis is likely. Conservative medical therapy, timely termination of pregnancy and surgical intervention are basic treatments. Controlling BMI and serum triglyceride and treating biliary diseases are important in preventing AP during pregnancy.