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腹部超声引导下两阶段内镜治疗妊娠期胆胰急腹症的价值

(2014-10-22 12:30:43)

                                

    腹部超声引导下两阶段内镜治疗妊娠期胆胰急腹症的价值= Ultrasonography-guided two-stage ERCP for emergent pancreatobiliary diseases during pregnancy

    [刊,中]/ 黄平1,张筱凤1,张啸1,吕文1,王霞1,方洁1,徐陈柯1,刘凤娟1,张皞2(1. 杭州市第一人民医院,杭州310006;2. 杭州市第六人民医院)//中华消化内镜杂志.—2012,29(2).—81~84

    探讨超声引导下两阶段ERCP治疗妊娠期胆胰急腹症的安全性及疗效。回顾性分析5年多来收治的32例妊娠期胆胰急腹症患者的临床资料。患者分两阶段行ERCP:先在腹部超声引导下行十二指肠乳头插管、括约肌小切开及放置塑料内支架,再于孕妇分娩2周后行系统的ERCP治疗。统计操作成功率,观察患者的临床症状缓解、实验室指标恢复,以及孕妇胎儿并发症发生情况。32例患者均有发热、胆绞痛及黄疸,超声或MRCP显示胆总管均扩张,其中24例有胆总管结石,8例急性胆管炎。患者在超声引导下均插管成功并顺利放入塑料内支架,临床症状明显缓解,1周后复查实验室指标明显改善(P<0.01)。第二阶段24例患者行ERCP下胆道结石清扫,3例胆管下段仍狭窄患者予更换内支架。发生胆道出血及轻型急性胰腺炎各1例,并发症发生率6.25%。随访12个月,孕妇及婴儿均健康。腹部超声引导下的两阶段ERCP治疗安全、有效,应作为妊娠期胆胰急腹症患者的首选治疗,且避免了胎儿辐射。表1参15(周昊)

    关键词:急腹症; 胆管炎; 胰腺炎; 妊娠;超声检查; 内窥镜逆行胰胆管造影术

    E-mail: coco770727@sina.com.cn

    Internal Medicine. Ultrasonography-guided two-stage ERCP for emergent pancreatobiliary diseases during pregnancy. To evaluate the safety and efficacy of ultrosonography-guided two-stage ERCP for management of emergent pancreatobiliary diseases during pregnancy. The clinical data of 32 consecutive pregnant women with suspected emergent pancreatobiliary diseases, who were treated with two-stage ultrasonography-guided ERCP from January 2005 to May 2010, were analyzed retrospectively. All patients were treated with ERCP in two stages. In stage , all the patients underwent ultrasonography-guided biliary cannulation, sphincterotomy with small incision and plastic stent placement during pregnancy. In stage , routine ERCP was performed in two weeks after delivery. The success rate of first ERCP, relief of clinical manifestation, improvement of lab indices, maternal and fetal complications were evaluated. All patients presented with fever, biliary colic and jaundice. Abdominal ultrasonography or magnetic resonance cholagiopancreatography (MRCP) revealed dilated common bile duct (CBD) in all patients, with CBD stones in 24 and acute cholangitis in 8. Bile duct cannulation and stent placement were successful in all patients. All patients markedly improved after first ERCP, with laboratory indices significantly improved at 1 week  after the procedure (P<0.01). In stage , CBD stones were retrieved in 24 patients under ERCP, including 2 cases of mechanical lithotripsy. Bile duct stenosis was found in 3 patients and plastic stents were replaced. Biliary bleeding occurred in 1 case, mild acute pancreatitis in another, with a complication rate at 6.25%. Patients and babies were followed up for 12 months and found to be  healthy. Two-stage ultrosonography-guided ERCP is safe and effective for pregnant patients with emergent pancreatobiliary diseases, which might be regarded as the first choice for such patients to avoid radiation.

    Key words: Abdomen,acute; Cholangitis; Pancreatitis; Pregnancy; Ultrasonography Endoscopic retrograde cholangiopancreatography

    HUANG Ping (Department of Gastroenterology, The First Renmin Hospital of Hangzhou, Hangzhou 310006, China), ZHANG Xiao-feng, ZHANG Xiao, et al//Chin J Dig Endosc,2012,29(2).81-84.

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个人资料
    张筱凤 单位:杭州市第一人民医院
    所属科室:
    出生:1976-03-17
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