Petersen Liselotte, Lauenborg Jeannet, Svare Jens, Nilas Lisbeth
Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Department of Obstetrics and Gynecology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark.
Obes Surg. 2017 Mar;27(3):688-693. doi: 10.1007/s11695-016-2339-1.
The aim of the present study was to describe the risk of internal herniation (IH) and the obstetric outcome in pregnant women with Roux-en-Y gastric bypass (RYGB) and episodes of upper abdominal pain.
The cohort included 133 women with RYGB: 94 with 113 pregnancies, from the local area referred for routine antenatal care (local cohort) and 39 with 40 pregnancies referred from other hospitals for specialist consultation due to RYGB. RYGB was mainly performed without closure of the mesenteric defects. Data collected from medical records were episodes of upper abdominal pain, pregestational and gestational abdominal surgery and pregnancy outcome. The risk of upper abdominal pain was estimated in the local cohort. Surgical intervention, IH and obstetric outcome according to pain were evaluated for 139 pregnancies with delivery of a singleton after 24 weeks of gestation (birth cohort).
Upper abdominal pain complicated 42/113 (37.2 %) pregnancies in the local cohort and 11 women (9.7 %) had IH. In the birth cohort, upper abdominal pain complicated 64/139 (46.0 %) pregnancies; surgery was performed in 30/64 (46.9 %), and IH diagnosed in 21/64 (32.8 %). The median gestational age at onset of pain was 25 + 3 weeks. Women reporting abdominal pain had a higher risk of preterm birth (n = 14/64 vs. 1/75, p < 0.005), lower median gestational length (269 vs. 278 days, p < 0.005) and lower median birth weight (3018 vs. 3281 g, p = 0.002) compared to women without abdominal pain.
Upper abdominal pain during pregnancy is frequent among women with Roux-en-Y gastric bypass, is often due to IH and is associated with adverse pregnancy outcome.
本研究旨在描述接受 Roux-en-Y 胃旁路术（RYGB）且有上腹部疼痛发作的孕妇发生内疝（IH）的风险及产科结局。
该队列包括 133 例接受 RYGB 的女性：94 例有 113 次妊娠，来自当地接受常规产前检查（当地队列）；39 例有 40 次妊娠，因 RYGB 从其他医院转诊来进行专科会诊。RYGB 主要在未封闭肠系膜缺损的情况下进行。从医疗记录中收集的数据包括上腹部疼痛发作情况、孕前和孕期腹部手术及妊娠结局。在当地队列中评估上腹部疼痛的风险。对 139 例妊娠 24 周后分娩单胎的孕妇（分娩队列），根据疼痛情况评估手术干预、IH 和产科结局。
在当地队列中，42/113（37.2%）的妊娠合并上腹部疼痛，11 名女性（9.7%）发生 IH。在分娩队列中，64/139（46.0%）的妊娠合并上腹部疼痛；30/64（46.9%）进行了手术，21/64（32.8%）诊断为 IH。疼痛发作时的中位孕周为 25 + 3 周。与无腹痛的女性相比，报告腹痛的女性早产风险更高（n = 14/64 对 1/75，p < 0.005），中位妊娠时长更短（269 天对 278 天，p < 0.005），中位出生体重更低（3018 g 对 3281 g，p = 0.002）。
接受 Roux-en-Y 胃旁路术的女性孕期上腹部疼痛很常见，常因内疝所致，且与不良妊娠结局相关。
