Güitrón-Cantú Alfredo, Adalid-Martínez Raúl, Gutiérrez-Bermúdez José A, Aguirre-Díaz Armando
Departamento de Endoscopia Digestiva, Hospital de Especialidades No 71, Instituto Mexicano del Seguro Social, Blvd. Revolución y Calle 26, C.P. 27000 Torreón, Coahuila.
Rev Gastroenterol Mex. 2003 Jan-Mar;68(1):11-5.
Gallstones and extrahepatic biliary obstruction is a difficult management problem during pregnancy. Choledocholithiasis may cause cholangitis or pancreatitis, potentially life-threatening conditions. As surgery may result in significant fetal mortality when performed on these patients. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) are preferred and could be performed safely in pregnant women provided suitable precautions are taken to minimize exposure to radiation.
To show our experience in ERCP and ES for symptomatic choledocholithiasis during pregnancy.
We described our experience in seven young women (mean age, 27.4 years) who presented with symptoms caused by choledocholithiasis, one in first trimester of pregnancy, four in second trimester, and two in third month. All had obstructive jaundice corroborated by abnormal liver function test and dilation of biliary tree on abdominal ultrasound.
All had ERCP, ES, and stone extraction without complication and went on to deliver healthy babies at term. A lead apron was positioned over the abdomen of the mother to shield the fetus during roentgenographic fluoroscopy. Mean fluoroscopy time was 26 (range, 5-60 sec).
Endoscopic management should be considered in women presenting with choledocholithiasis during pregnancy.
胆结石和肝外胆管梗阻是孕期管理中的难题。胆总管结石可能导致胆管炎或胰腺炎，这些情况可能危及生命。由于对这些患者进行手术可能导致显著的胎儿死亡率。内镜逆行胰胆管造影（ERCP）和内镜括约肌切开术（ES）是首选方法，只要采取适当的预防措施以尽量减少辐射暴露，就可以在孕妇中安全进行。
展示我们在孕期对有症状的胆总管结石进行ERCP和ES的经验。
我们描述了对7名年轻女性（平均年龄27.4岁）的经验，她们因胆总管结石出现症状，其中1例处于妊娠早期，4例处于妊娠中期，2例处于妊娠晚期。所有患者肝功能检查异常及腹部超声显示胆管树扩张，均证实有梗阻性黄疸。
所有患者均接受了ERCP、ES及结石取出术，无并发症发生，并足月分娩出健康婴儿。在X线透视期间，在母亲腹部放置铅围裙以保护胎儿。平均透视时间为26秒（范围5 - 60秒）。
对于孕期出现胆总管结石的女性，应考虑内镜治疗。
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