CAJ | 학술논문

目的探讨内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗妊娠合并急性胆管炎的效果及安全性.方法对本院2001年8月至2009年2月采用ERCP联合乳头切开术(endoscopic sphincterotomy,EST)治疗的16例妊娠合并急性胆管炎患者的临床资料进行回顾性分析.结果2例于妊娠3个月(妊娠早期)时行ERCP术+塑料内支架引流,未行EST取石,分别于术后4个月和5个月后内支架堵塞,再次行EST术取石.8例妊娠中期病例,7例一次性EST取净结石;1例因胆总管有多枚结石,行EST部分取石后放置塑料内支架,分娩后2周再行ERCP术取净结石.6例妊娠末3个月患者,5例1次行EST术取石成功;1例造影见胆总管结石多枚,直接放置塑料内支架1根引流,分娩1个月后,再行ERCP术取净结石.1例妊娠末3个月患者术后并发急性轻型胰腺炎,经治疗后痊愈;其余病例无术后并发症发生.全部病例随访至胎儿出生后1个月,未发现早产和宫内胎儿窘迫病例,无畸形、发育迟缓、智力低下儿出生.结论短期随访显示,ERCP治疗妊娠合并急性胆管炎安全有效.但目前尚缺乏射线对胎儿是否有影响的长期随访结果.
목적탐토내경하역행이담관조영술(endoscopic retrograde cholangiopancreatography,ERCP)치료임신합병급성담관염적효과급안전성.방법대본원2001년8월지2009년2월채용ERCP연합유두절개술(endoscopic sphincterotomy,EST)치료적16례임신합병급성담관염환자적림상자료진행회고성분석.결과2례우임신3개월(임신조기)시행ERCP술+소료내지가인류,미행EST취석,분별우술후4개월화5개월후내지가도새,재차행EST술취석.8례임신중기병례,7례일차성EST취정결석;1례인담총관유다매결석,행EST부분취석후방치소료내지가,분면후2주재행ERCP술취정결석.6례임신말3개월환자,5례1차행EST술취석성공;1례조영견담총관결석다매,직접방치소료내지가1근인류,분면1개월후,재행ERCP술취정결석.1례임신말3개월환자술후병발급성경형이선염,경치료후전유;기여병례무술후병발증발생.전부병례수방지태인출생후1개월,미발현조산화궁내태인군박병례,무기형、발육지완、지력저하인출생.결론단기수방현시,ERCP치료임신합병급성담관염안전유효.단목전상결핍사선대태인시부유영향적장기수방결과.
Objective To explore the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute cholangitis during pregnancy. Methods The clinical data of 16 pregnant patients with acute cholangitis who underwent ERCP and/or endoscopic sphincterotomy (EST) from August 2001 to February 2009 were retrospectively analyzed. Results Two patients were in the first trimester, 8 in the second trimester and 6 in the third trimester of pregnancy. Two patients had endoscopic placement of a plastic biliary stent in the first trimester. EST was then used to remove the stones successfully 4 and 5 months later. ERCP was performed in 8 women in the second trimester and 6 in their third trimester. Successful clearance of biliary stones at the time of ERCP was achieved in 14 pregnant women. Two patients who had multiple biliary stones underwent placement of a plastic biliary stent to limit the total fluoroscopy time. A second ERCP was carried out on the 2 patients to remove the stones after delivery. Post-ERCP mild pancreatitis developed in 1 patient in the third trimester. There was no spontaneous fetal loss, premature births, intrauterine fetal distress, fetal growth retardation/mental retardation/fetal malformation. Conclusion Short-term follow-up of all neonates whose mothers received ERCP during their pregnancies supported the efficacy and safety of its use. However, the long-term fetal complications of radiation exposure have not been investigated.