Chiappetta Porras Luis Tomás, Nápoli Eduardo Daniel, Canullán Carlos Manuel, Quesada Bernabé Matías, Roff Hernán Eduardo, Alvarez Rodríguez Juan, Oría Alejandro Salvador
Department of Surgery, Cosme Argerich Hospital, Almirante Brown 240, Buenos Aires 1155, Argentina.
HPB Surg. 2009;2009:829020. doi: 10.1155/2009/829020. Epub 2009 Jul 12.
Acute biliary diseases during pregnancy have been classically managed conservatively. Advances in minimally invasive surgery and the high recurrence rate of symptoms observed changed this management.
This is a prospective observational study. Initial management was medical. Unresponsive patients were treated with minimally invasive techniques including gallbladder percutaneous aspiration or cholecystostomy, endoscopic retrograde cholangiography, and laparoscopic cholecystectomy, depending on the pregnancy trimester and underlying diagnosis.
122 patients were admitted. 69 (56.5%) were unresponsive to medical treatment. Recurrent gallbladder colic was the most frequent indication for minimally invasive intervention, followed by acute cholecystitis, choledocholithiasis, and acute biliary pancreatitis. 8 patients were treated during the first trimester, 54 during the second, and 7 during the last trimester. There was no fetal morbidity or mortality. Maternal morbidity was minor with no mortality.
Acute biliary tract diseases during pregnancy may be safely treated with minimally invasive procedures according to the underlying diagnosis and to the trimester of pregnancy.
妊娠期急性胆道疾病传统上采用保守治疗。微创外科手术的进展以及观察到的高症状复发率改变了这种治疗方式。
这是一项前瞻性观察研究。初始治疗为药物治疗。对药物治疗无反应的患者根据妊娠 trimester 和潜在诊断，采用包括经皮胆囊穿刺抽吸或胆囊造瘘术、内镜逆行胆管造影术和腹腔镜胆囊切除术在内的微创技术进行治疗。
122 例患者入院。69 例（56.5%）对药物治疗无反应。复发性胆囊绞痛是微创干预最常见的指征，其次是急性胆囊炎、胆总管结石和急性胆源性胰腺炎。8 例患者在孕早期接受治疗，54 例在孕中期，7 例在孕晚期。无胎儿发病或死亡情况。母体发病率较低，无死亡病例。
妊娠期急性胆道疾病可根据潜在诊断和妊娠 trimester 采用微创方法安全治疗。
