CAJ | 학술논문

目的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.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.结果 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.结论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.
목적 탐토초성인도하량계단ERCP치료임신기담이급복증적안전성급료효.방법 회고성분석5년다래수치적32례임신기담이급복증환자적림상자료.환자분량계단행ERCP:선재복부초성인도하행십이지장유두삽관、괄약기소절개급방치소료내지가,재우잉부분면2주후행계통적ERCP치료.통계조작성공솔,관찰환자적림상증상완해、실험실지표회복,이급잉부태인병발증발생정황.결과 32례환자균유발열、담교통급황달,초성혹MRCP현시담총관균확장,기중24례유담총관결석,8례급성담관염.환자재초성인도하균삽관성공병순리방입소료내지가,림상증상명현완해,1주후복사실험실지표명현개선(P＜0.01).제이계단24례환자행ERCP하담도결석청소,3례담관하단잉협착환자여경환내지가.발생담도출혈급경형급성이선염각1례,병발증발생솔6.25％.수방12개월,잉부급영인균건강.결론 복부초성인도하적량계단ERCP치료안전、유효,응작위임신기담이급복증환자적수선치료,차피면료태인복사.
Objective 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 ultrasonographyguided 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 1week 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 Twostage 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.