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B超引导下两阶段ERCP治疗妊娠期胆胰急腹症

(2014-10-22 12:27:54)

    作者单位:310006 杭州,杭州市第一人民医院消化内科(黄平、张筱凤、张啸、吕文、王霞、方洁),B超室(徐陈柯),妇产科(刘凤娟);杭州市第六人民医院(张皞)

    [摘要]目的  探讨B超引导下两阶段ERCP治疗妊娠期胆胰急腹症的安全性及疗效。方法  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B超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。结果  32例患者均有发热、胆绞痛及黄疸,B超或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B超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。结论  B超引导下的两阶段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。

    [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

    Ultrasonography-guided two-stage ERCP for emergent pancreatobiliary diseases during pregnancy. HUANG Ping*, ZHANG Xiao-feng, ZHANG Xiao, LV Wen, WANG Xia, FANG Jie, XU Chen-ke, LIU Feng-juan, ZHANG Hao. *Department of Gastroenterology, The First Renmin Hospital of Hangzhou, Hangzhou 310006, China

    Corresponding author: ZHANG Hao, Email: coco770727@sina.com.cn

    [Abstract]Objectives  To evaluate the safety and efficacy of ultrosonography-guided two-stage ERCP for management of emergent pancreatobiliary diseases during pregnancy. Methods  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 I, all the patients underwent ultrasonography-guided biliary cannulation, sphincterotomy with small incision and plastic stent placement during pregnancy. In stage II, 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. Results   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 II, 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. Conclusion  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;ultrasonographyendoscopic retrograde cholangiopancreatography

     

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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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