Scott L D
Division of Gastroenterology, University of Texas Medical School, Houston.
Gastroenterol Clin North Am. 1992 Dec;21(4):803-15.
Controversy exists over whether pregnancy is a risk factor for gallstone formation; however, changes in hepatobiliary function do occur during pregnancy to create a lithogenic environment; these changes include gallbladder stasis and secretion of bile with increased amounts of cholesterol and decreased amounts of chenodeoxycholic acid. In women with existing gallstones, pregnancy may bring out symptoms, including pain and even acute cholecystitis. This may be more common during the postpartum period than during pregnancy itself; however, the overall occurrence of symptomatic biliary disease in association with pregnancy is low. The effects of pregnancy, if any, on pancreatic exocrine function are undefined. Acute pancreatitis can occur during pregnancy but does not appear to do so with either increased or, alternatively, decreased frequency. The concept of pancreatitis caused by pregnancy per se is not valid, although in susceptible women with lipid disorders, hypertriglyceridemia can occur and serve as an etiologic factor. Gallstones are a common cause of pancreatitis, but in contrast to nonpregnant women, alcohol is unusual as a cause. Although the presentation of both acute cholecystitis and acute pancreatitis may be similar to that in the nonpregnant state, the differential diagnosis of both these disorders is expanded because of unique pregnancy-related conditions and the shift of abdominal viscera by the enlarging uterus. The diagnosis is clinical and supported with conventional laboratory studies and ultrasound; management is supportive and in most patients successful. Cholecystectomy is seldom necessary during pregnancy, either for acute cholecystitis or gallstone pancreatitis, but can be safely performed if necessary after the first trimester. Endoscopic papillotomy and stone removal for choledocholithiasis are possible during pregnancy and may be the treatment of choice for this unusual condition. Specific enteral or parenteral nutrition may be necessary in women with pancreatitis associated with hypertriglyceridemia.
关于妊娠是否为胆结石形成的危险因素存在争议；然而，妊娠期间肝胆功能确实会发生变化，从而形成致石环境；这些变化包括胆囊淤滞以及胆汁分泌中胆固醇含量增加和鹅去氧胆酸含量减少。对于已有胆结石的女性，妊娠可能引发症状，包括疼痛甚至急性胆囊炎。这在产后阶段可能比妊娠期间更为常见；然而，与妊娠相关的有症状胆道疾病的总体发生率较低。妊娠对胰腺外分泌功能（若有影响）尚不明确。急性胰腺炎可在妊娠期间发生，但发生率似乎并未增加或减少。妊娠本身导致胰腺炎的概念并不成立，尽管在患有脂质紊乱的易感女性中，可能会出现高甘油三酯血症并成为病因。胆结石是胰腺炎的常见病因，但与非妊娠女性不同，酒精很少作为病因。尽管急性胆囊炎和急性胰腺炎的表现可能与非妊娠状态相似，但由于与妊娠相关的独特情况以及增大的子宫导致腹腔脏器移位，这两种疾病的鉴别诊断范围扩大。诊断依靠临床症状，并通过传统实验室检查和超声检查来支持；治疗以支持治疗为主，大多数患者治疗成功。对于急性胆囊炎或胆结石性胰腺炎，妊娠期间很少需要进行胆囊切除术，但如果有必要，在孕早期过后可以安全地进行。妊娠期间可行内镜乳头切开术和胆总管结石取出术，这可能是这种特殊情况的首选治疗方法。对于伴有高甘油三酯血症的胰腺炎女性，可能需要特定的肠内或肠外营养支持。
