Department of Gastroenterology, First People's Hospital of Hangzhou, Hangzhou, Zhejiang 310006, China.
Chin Med J (Engl). 2013 Jan;126(1):46-50.
Currently, the recommendation when treating acute biliary or pancreatic disease during pregnancy is to perform endoscopic retrograde cholangiopancreatography (ERCP) without radiation exposure, either empirically (with no radiographic guidance) or with ultrasound guidance. However, few published studies compared these two ways. This study aimed to compare ultrasound-guided ERCP with the procedure without radiographic guidance in the treatment of acute pancreaticobiliary disease in pregnant patients.
The clinical data of 68 pregnant patients with acute pancreaticobiliary disease admitted to our hospital between January 2004 and May 2010 were reviewed retrospectively. ERCP was performed without radiographic guidance in 36 cases (group A) and with ultrasound guidance in 32 cases (group B). Data on the following variables were compared between the two groups: surgical success rate, rate of complete stone removal, time to resolution of clinical manifestations and laboratory indicators, length of hospital stay, complications, outcome and differences in efficacy of ERCP during different stages of pregnancy.
In group A, the rates of surgical success and complete removal of stones were 69% and 60%, respectively; the corresponding values were 91% and 89% in group B (P < 0.05). Postoperatively, clinical manifestations improved rapidly in all patients; there was no statistically significant difference between the groups (P > 0.05). Leukocyte counts and liver function had improved significantly after one week in all patients; they recovered more quickly in group B ((8.64 ± 1.83) days vs. (14.57 ± 3.74) days, (14.29 ± 4.64) days vs. (20.00 ± 5.40) days, P < 0.01). The hospital stay was shorter in group B ((16.28 ± 7.25) days vs. (28.00 ± 6.83) days, P < 0.001). The complication rate was 14% in group A and 3% in group B (P < 0.05). There were no significant differences between the two groups in the procedure's efficacy during different stages of pregnancy.
In the treatment of acute pancreaticobiliary disease during pregnancy, ultrasound-guided ERCP is safer and more effective than performing the procedure empirically without radiographic guidance when performed by experienced practitioners. Its more widespread use is recommended.
目前，对于妊娠期急性胆胰疾病的治疗建议是行内镜逆行胰胆管造影术（ERCP），且不暴露于射线，或在超声引导下进行。然而，很少有发表的研究比较这两种方法。本研究旨在比较超声引导下 ERCP 与无射线引导下 ERCP 在治疗妊娠患者急性胆胰疾病中的效果。
回顾性分析 2004 年 1 月至 2010 年 5 月我院收治的 68 例妊娠期急性胆胰疾病患者的临床资料。36 例行无射线引导下 ERCP（A 组），32 例行超声引导下 ERCP（B 组）。比较两组患者的手术成功率、完全取石率、临床症状及实验室指标缓解时间、住院时间、并发症、转归以及妊娠不同时期 ERCP 效果的差异。
A 组手术成功率和完全取石率分别为 69%和 60%，B 组分别为 91%和 89%（P<0.05）。术后所有患者临床症状均迅速改善，两组间差异无统计学意义（P>0.05）。所有患者白细胞计数和肝功能均在术后 1 周内明显改善，B 组恢复更快[（8.64±1.83）天比（14.57±3.74）天，（14.29±4.64）天比（20.00±5.40）天，P<0.01]。B 组住院时间更短[（16.28±7.25）天比（28.00±6.83）天，P<0.001]。A 组并发症发生率为 14%，B 组为 3%（P<0.05）。妊娠不同时期两组患者 ERCP 效果差异无统计学意义。
对于妊娠期急性胆胰疾病，有经验的操作者行超声引导下 ERCP 较无射线引导下经验性 ERCP 更安全、有效，建议广泛应用。
