Hedström Jonas, Nilsson Johan, Andersson Roland, Andersson Bodil
a Department of Clinical Sciences Lund, Surgery, Skane University Hospital , Lund University , Lund , Sweden.
b Department of Clinical Sciences Lund, Cardiothoracic Surgery , Skane University Hospital, Lund University , Lund , Sweden.
Scand J Gastroenterol. 2017 Sep;52(9):1016-1021. doi: 10.1080/00365521.2017.1333627. Epub 2017 Jun 9.
Gallstone-related disease is the second most common non-obstetric cause, following appendicitis, for acute abdomen in pregnancy. This study aimed to investigate treatment strategies, changes over time and outcome.
All consecutive patients with symptomatic gallstone-related disease during pregnancy admitted to Skane University hospital in Lund and Malmö 2001-2015 were analysed retrospectively. Information regarding the patient, pregnancy and fetus/child was recorded. The material was analysed by dividing it into two equal time periods and by comparing conservative management and surgical intervention.
We included 96 patients with 97 pregnancies. The age was 30 (26-34) years and BMI 28 (24-31). Median length of pregnancy at first admission was 23 (13-31) weeks. The three most common diagnoses were biliary colic (n = 63), cholecystitis (n = 22) and acute pancreatitis (n = 16). Conservative treatment was practiced in 62 (64%) patients and intervention in 35 (36%). Conservatively treated patients were admitted later during pregnancy (week 26 (20-33) versus 17 (10-22), p < .001). Surgically treated patients had a longer total length of stay (all admissions) than conservatively treated patients (p = .001), less readmissions (p = .001) and equal birth outcome. Surgical intervention was more common in the later time period (48% versus 22%, p = .011). Of the conservatively treated patients, 56% were subjected to surgical intervention within 2 years after delivery.
We found that intervention was more common in the later time period, with good results concerning safety, and less readmissions. A majority of the conservatively treated patients had surgical intervention within two years after delivery. Our results support surgical intervention in pregnancy.
胆石相关疾病是妊娠急性腹痛的第二大常见非产科病因，仅次于阑尾炎。本研究旨在探讨治疗策略、随时间的变化及结局。
对2001年至2015年期间在隆德和马尔默的斯坎讷大学医院住院的所有连续妊娠期间患有症状性胆石相关疾病的患者进行回顾性分析。记录有关患者、妊娠及胎儿/儿童的信息。将资料分为两个相等的时间段，并比较保守治疗和手术干预，进行分析。
我们纳入了96例患者的97次妊娠。年龄为30（26 - 34）岁，体重指数为28（24 - 31）。首次入院时的妊娠中位数时长为23（13 - 31）周。最常见的三种诊断为胆绞痛（n = 63）、胆囊炎（n = 22）和急性胰腺炎（n = 16）。62（64%）例患者采用保守治疗，35（36%）例患者采用干预治疗。保守治疗的患者在妊娠后期入院（第26（20 - 33）周与第17（10 - 22）周，p <.001）。接受手术治疗的患者总住院时长（所有入院情况）比保守治疗的患者长（p = .001），再次入院率更低（p = .001），且分娩结局相同。手术干预在后期更常见（48%对22%，p = .011）。在保守治疗的患者中，56%在分娩后2年内接受了手术干预。
我们发现后期干预更常见，在安全性方面效果良好，再次入院率更低。大多数保守治疗的患者在分娩后两年内接受了手术干预。我们的结果支持在妊娠期间进行手术干预。
