CAJ | 학술논문

目的：总结妊娠合并急性胰腺炎(acute pancreatitis in pregnancy，APIP)的发病特点和诊疗经验。方法对2010年1月-2014年11月解放军总医院收治的12例24~40岁 APIP 患者的发病、治疗和转归进行回顾性分析，并与同时期24例年龄22~39岁的青年女性非妊娠期急性胰腺炎患者(对照组)进行比较。结果与对照组相比，APIP 组血清三酰甘油水平显著升高[(4.62±5.21) mmol/L vs (1.91±1.90) mmol/L，P=0.003]，白细胞、血红蛋白、总胆固醇、血钙、空腹血糖两组差异无统计学意义。发病前1 d 内高脂饮食及发病时胆囊结石发生情况、住院时间两组差异无统计学意义。12例 APIP 患者中，临床治愈、未出现任何并发症者10例，出现胰腺假性囊肿形成继发性糖尿病1例，死亡1例。因胎儿宫内窘迫行剖宫产胎儿死亡1例，于发病期间行引产1例，胰腺炎治愈后应患者要求行引产1例，胎儿存活9例。结论在 APIP 中高脂血症可能是危险因素，应监测血脂，注意饮食，避免过度进补；治疗需考虑母婴双重影响，实行个体化治疗。
목적：총결임신합병급성이선염(acute pancreatitis in pregnancy，APIP)적발병특점화진료경험。방법대2010년1월-2014년11월해방군총의원수치적12례24~40세 APIP 환자적발병、치료화전귀진행회고성분석，병여동시기24례년령22~39세적청년녀성비임신기급성이선염환자(대조조)진행비교。결과여대조조상비，APIP 조혈청삼선감유수평현저승고[(4.62±5.21) mmol/L vs (1.91±1.90) mmol/L，P=0.003]，백세포、혈홍단백、총담고순、혈개、공복혈당량조차이무통계학의의。발병전1 d 내고지음식급발병시담낭결석발생정황、주원시간량조차이무통계학의의。12례 APIP 환자중，림상치유、미출현임하병발증자10례，출현이선가성낭종형성계발성당뇨병1례，사망1례。인태인궁내군박행부궁산태인사망1례，우발병기간행인산1례，이선염치유후응환자요구행인산1례，태인존활9례。결론재 APIP 중고지혈증가능시위험인소，응감측혈지，주의음식，피면과도진보；치료수고필모영쌍중영향，실행개체화치료。
Objective To investigate the pathogenesis and therapeutic strategies of acute pancreatitis in pregnancy (APIP). Methods A retrospective analysis was performed in terms of the characteristics, treatment managements, and clinical outcomes in 12 patients with APIP admitted to Chinese PLA General Hospital from January 2010 to November 2014. The control group consisted of 24 acute pancreatitis patients without pregnancy aged 22-39 years during the same period. Results The content of serum triglyceride in APIP group was significantly higher than control group [(4.62±5.21) mmol/L vs (1.91±1.90) mmol/L, P=0.003]. However, there were no differences between two groups in white blood cell count, hemoglobin concentration, serum total cholesterol, serum calcium and fasting blood glucose. Also, there were no significant differences in the incidence of premorbid high-fat diet, as well as in the incidence of cholecystolithiasis and length of stay in hospital between two groups. In APIP group, 10 patients were cured clinically without any complications, one case was complicated with pancreatic pseudocyst as well as secondary diabetes mellitus, and one patient died of multiple organ dysfunction syndrome (MODS). One case had a fetal death due to intrauterine distress followed by cesarean section, one case underwent labor induction in the course of pancreatitis and one case requested automatic termination of pregnancy after she was cured. Nine infants survived. Conclusion Hyperlipidemia may be one of the risk factors in pathogenesis of APIP. It is necessary to monitor blood lipid and pay attention to diet, especially in avoiding excessive tonic. Clinicians need to take both mothers and fetuses into consideration for individualized treatment.