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目的:探讨妊娠期急性胰腺炎(APIP)的病因、临床特点、治疗及预后。方法:收集1995年2月~2013年7月北京大学第一医院收治的15例APIP患者的临床资料,分析其临床特点。结果:15例妊娠合并急性胰腺炎的患者中轻症10例、重症5例。主要临床表现为持续性上腹部疼痛及剑突下疼痛(14例);消化道症状如恶心、呕吐(11例),发热(4例),中上腹压痛(11例),腹膜炎体征(6例),乳糜血(3例)。5例合并高脂血症、脂肪肝,5例合并胆囊炎、胆道结石。早孕期3例、中孕期3例、晚孕期8例、产褥期1例。4例患者保守治疗成功后继续妊娠;6例行剖宫产术,其中1例同时行胆囊切除术+胰腺坏死感染组织清除术+鼻胆管引流术,3例患者术后行血液透析滤过联合血浆置换治疗。11例新生儿中2例放弃治疗,其他9例均存活。结论:胆道疾病及高脂血症是APIP的重要病因,早期诊断和正确治疗是影响预后的关键。
Objective: To investigate the etiology, clinical features, treatment and prognosis of acute pancreatitis during pregnancy (APIP). Methods: The clinical data of 15 APIP patients admitted from the First Hospital of Peking University from February 1995 to July 2013 were collected and their clinical features were analyzed. Results: 15 cases of mild acute pancreatitis patients with pregnancy in 10 cases, 5 cases of severe. The main clinical manifestations were persistent upper abdominal pain and xiphoid pain (n = 14); gastrointestinal symptoms such as nausea and vomiting (n = 11), fever (n = 4) Cases), chyle blood (3 cases). 5 cases of hyperlipidemia, fatty liver, 5 cases of cholecystitis, biliary stones. 3 cases in early pregnancy, 3 cases in middle pregnancy, 8 cases in late pregnancy and 1 case in puerperium. 4 cases of patients continued conservative treatment after pregnancy success; 6 cases of cesarean section, including 1 case of simultaneous cholecystectomy + pancreatic necrosis infected tissue removal + nasobiliary drainage, 3 patients underwent hemodialysis filtration union Plasma exchange treatment. Two of the 11 neonates gave up treatment, and the other nine survived. Conclusion: Biliary disease and hyperlipidemia are important causes of APIP. Early diagnosis and correct treatment are the keys to prognosis.