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妊娠期胆石症与其并发症的保守治疗与复发症状和急诊患者增加相关

发布日期:2014-1-29 12:40:51 文章来源:ENDOSCOPY 作者次数:1370
    背景

    胰胆结石并发症多见于妊娠期妇女,它可导致严重的后遗症。之前的研究已经表明,采用不同的治疗方法可产生相矛盾的结果。

    目的

    比较保守治疗与手术和内镜干预治疗妊娠期间与结石相关的并发症的疗效。

    设计

    回顾性病历审查。

    环境

    三级转诊机构。

    患者

    112例患者妊娠期间患胆结石相关的并发症。

    干预

    将患者分为三组:保守治疗组,腹腔镜胆囊切除术(LC)和内镜下逆行胰胆管造影术组(ERCP)。

    主要测量指标

    我们收集了关于治疗并发症和妊娠结果的有关人口资料和信息。

    结果

    112例怀孕患者(平均年龄为25岁)符合纳入标准。主要临床表现为胆绞痛(n =56)、胆源性胰腺炎(n = 27)、急性胆囊炎(n =17)和胆总管结石病(n =12)。共68例患者接受了保守治疗,13例接受了ERCP27例接受LC,而且有4例既接受了ERCP,又接受了LC治疗。复发性胆道症状在接受保守治疗的患者更常见(P = 0.0005)。保守治疗组中的急诊病患数量显著多于急性干预组(P = 0.0006)。同时,保守治疗组住院人数也较高(P = 0.03)。两组中胎儿出生体重相似(P =0.1)。接受保守治疗的患者分娩时接受剖腹产术的可能性更大(P = 0.04)。

    局限性

    单中心回顾性研究。

    结论

    妊娠期胆石症与其并发症的保守治疗与复发性胆道症状和急诊患者增加相关。对妊娠患者,ERCP LC是安全的替代方法。

    缩写词:APGARCBD,胆总管;LC,腹腔镜胆囊切除术


     

    Conservative management of cholelithiasis and its complications in pregnancy is associated with recurrent symptoms and more emergency department visits

    Received 17 January 2012; accepted 30 April 2012. published online 25 June 2012.

    Background

    Pancreaticobiliary complications of gallstones are common in pregnancy and can result in serious sequelae. Previous studies have shown conflicting results regarding different approaches of treatment.

    Objective

    To compare the outcomes of conservative treatment versus operative and endoscopic interventions in the management of complications related to gallstones during pregnancy.

    Design

    Retrospective chart review.

    Setting

    Tertiary-care referral facility.

    Patients

    A total of 112 patients who had complications related to gallstones during pregnancy.

    Intervention

    Patients were classified into 3 groups: conservative treatment, laparoscopic cholecystectomy (LC), and ERCP.

    Main Outcome Measurements

    We collected demographic data and information regarding treatment complications and pregnancy outcomes.

    Results

    A total of 112 pregnant patients met the inclusion criteria, with a mean age of 25 years. Main clinical presentations were biliary colic (n = 56), biliary pancreatitis (n = 27), acute cholecystitis (n = 17), and choledocholithiasis (n = 12). A total of 68 patients underwent conservative treatment, 13 patients underwent ERCP, 27 patients had LC, and 4 patients received both ERCP and LC. Recurrent biliary symptoms were significantly more common in patients who received conservative treatment (P = .0005). The number of emergency department visits was significantly higher in the conservative treatment group compared with the active intervention group (P = .0006). The number of hospitalizations also was higher in the conservative treatment group (P = .03). Fetal birth weight was similar in both groups (P = .1). Patients treated conservatively were more likely to undergo cesarean section operations for childbirth (P = .04).

    Limitations

    Single-center, retrospective study.

    Conclusion

    Conservative treatment of cholelithiasis and its complications during pregnancy is associated with recurrent biliary symptoms and frequent emergency department visits. ERCP and LC are safe alternative approaches during pregnancy.

    Abbreviations:  APGAR, American Pediatric Gross Assessment Record, CBD, common bile duct, LC, laparoscopic cholecystectomy

     

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