妊娠合并急性胰腺炎10例临床分析

目的 探讨妊娠合并急性胰腺炎的临床特征、诊断、治疗、预防措施以及其对孕产妇和胎儿的影响,提高妊娠合并急性胰腺炎的诊治水平。方法 对2008年10月至2015年7月安徽医科大学附属巢湖医院收治的共10例妊娠合并急性胰腺炎患者的资料进行回顾性分析。结果 患者平均年龄29.6岁,10例患者中,轻型急性胰腺炎9例,重型急性胰腺炎1例。2例妊娠足月胎儿成熟均剖宫产终止妊娠获活男婴,3例保守治疗好转出院后随访均获活婴,3例保守治疗好转后终止妊娠。获得的活婴儿随访均无明显发育及智力异常。所有孕产妇无一例死亡,无一例胎死宫内。结论 妊娠合并急性胰腺炎易发生在妊娠中晚期及产褥期,其主要病因是胆管疾病、高脂血症及高脂高蛋白饮食,治疗以内科保守治疗为主,并严密监测孕妇和胎儿的情况,一旦胎儿脏器成熟,应及时终止妊娠。多专科协作治疗,可降低母婴病死率。

Clinical analysis of 10 cases of acute pancreatitis in pregnancy

Objective To investigate the clinical features, diagnosis and treatment, prevention measures of acute pancreatitis in pregnancy(APIP), and its effect on the maternal and fetal outcome, so as to improve the diagnostic level of APIP. Methods The clinical records of 10 patients with APIP ever treated in the Affiliated Chaohu Hospital of Anhui Medical University between Oct 2008 and Jul 2015 were retrospectively analyzed. Results The average age of patients was 29.6 years old. Among the 10 patients, mild acute pancreatitis(MAP) occurred in 9 patients, while severe acute pancreatitis(SAP) occurred in the rest one. 2 patients of full-term pregnancy underwent cesarean section and got 2 live male births, and other 6 cases were relieved after conservative treatment and 3 of them selected pregnancy termination. All the follow-up neonates were alive and healthy, without obvious mental abnormalities. No APIP patient died and no stillbirth was found. Conclusion Most APIP occur in the period of middle and late pregnancy and puerperium. The main pathogenic factors of APIP are biliary tract disease, hyperlipidemia, and high fat and protein diet, so the conservative therapy with intensive monitoring of maternal and fetal situation is generally preferred. For the APIP patients with organ-matured fetus, surgical intervention of pregnancy termination is necessary, and a favorable multidisciplinary cooperation could reduce the maternal and fetal mortality.