Division of Gastroenterology, Department of Internal Medicine, Texas Tech University at El Paso, El Paso, Texas 79905, USA.
Gastrointest Endosc. 2012 Sep;76(3):564-9. doi: 10.1016/j.gie.2012.04.475. Epub 2012 Jun 23.
BACKGROUND: Pancreaticobiliary complications of gallstones are common in pregnancy and can result in serious sequelae. Previous studies have shown conflicting results regarding different approaches of treatment. OBJECTIVE: To compare the outcomes of conservative treatment versus operative and endoscopic interventions in the management of complications related to gallstones during pregnancy. DESIGN: Retrospective chart review. SETTING: Tertiary-care referral facility. PATIENTS: A total of 112 patients who had complications related to gallstones during pregnancy. INTERVENTION: Patients were classified into 3 groups: conservative treatment, laparoscopic cholecystectomy (LC), and ERCP. MAIN OUTCOME MEASUREMENTS: We collected demographic data and information regarding treatment complications and pregnancy outcomes. RESULTS: A total of 112 pregnant patients met the inclusion criteria, with a mean age of 25 years. Main clinical presentations were biliary colic (n = 56), biliary pancreatitis (n = 27), acute cholecystitis (n = 17), and choledocholithiasis (n = 12). A total of 68 patients underwent conservative treatment, 13 patients underwent ERCP, 27 patients had LC, and 4 patients received both ERCP and LC. Recurrent biliary symptoms were significantly more common in patients who received conservative treatment (P = .0005). The number of emergency department visits was significantly higher in the conservative treatment group compared with the active intervention group (P = .0006). The number of hospitalizations also was higher in the conservative treatment group (P = .03). Fetal birth weight was similar in both groups (P = .1). Patients treated conservatively were more likely to undergo cesarean section operations for childbirth (P = .04). LIMITATIONS: Single-center, retrospective study. CONCLUSION: Conservative treatment of cholelithiasis and its complications during pregnancy is associated with recurrent biliary symptoms and frequent emergency department visits. ERCP and LC are safe alternative approaches during pregnancy.
背景：胆石症的胰胆管并发症在妊娠中很常见，可导致严重的后遗症。先前的研究表明，不同的治疗方法结果存在差异。
目的：比较保守治疗与手术和内镜介入治疗在妊娠期间胆石症相关并发症管理中的疗效。
设计：回顾性病历分析。
设置：三级医疗转诊机构。
患者：共有 112 例妊娠期间胆石症相关并发症患者。
干预：患者分为 3 组：保守治疗、腹腔镜胆囊切除术（LC）和内镜逆行胰胆管造影术（ERCP）。
主要观察指标：收集人口统计学数据以及治疗并发症和妊娠结局信息。
结果：共有 112 例符合纳入标准的妊娠患者，平均年龄 25 岁。主要临床表现为胆绞痛（n = 56）、胆源性胰腺炎（n = 27）、急性胆囊炎（n = 17）和胆总管结石（n = 12）。68 例患者接受保守治疗，13 例患者接受 ERCP，27 例患者行 LC，4 例患者同时接受 ERCP 和 LC。接受保守治疗的患者复发性胆系症状明显更常见（P =.0005）。与积极干预组相比，保守治疗组急诊就诊次数明显更多（P =.0006）。保守治疗组的住院次数也更高（P =.03）。两组胎儿出生体重相似（P =.1）。接受保守治疗的患者更有可能因分娩而行剖宫产术（P =.04）。
局限性：单中心、回顾性研究。
结论：妊娠期间胆石症及其并发症的保守治疗与复发性胆系症状和频繁急诊就诊相关。ERCP 和 LC 是妊娠期间安全的替代治疗方法。
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