Jamidar P A, Beck G J, Hoffman B J, Lehman G A, Hawes R H, Agrawal R M, Ashok P S, Ravi T J, Cunningham J T, Troiano F
Hospital of the Good Samaritan, Los Angeles, California, USA.
Am J Gastroenterol. 1995 Aug;90(8):1263-7.
Pancreaticobiliary disease in pregnancy is relatively uncommon. The frequency of choledocholithiasis in pregnancy requiring intervention has been reported to be as low as one in 1200 deliveries. Traditionally, intervention in these patients has been surgical. Although surgery has an overall low morbidity and mortality for the expectant mother, it carries with it a 4- to 6-wk recovery period and a possibly increased risk of fetal wastage. Published information regarding the role and safety of ERCP in pregnancy is limited. This series of 23 pregnant patients undergoing ERCP was collected from six different medical centers.
Twenty-three pregnant patients with symptomatic pancreaticobiliary disease underwent a total of 29 ERCPs (three patients had diagnostic ERCP, and 20 had therapeutic ERCP). Fifteen, eight, and six procedures were performed in the first, second, and third trimesters, respectively. The only ERCP complication was pancreatitis in one patient. There was one spontaneous abortion (3 months after ERCP) and one neonatal death; however, casual relationship to ERCP was not apparent.
Diagnostic and therapeutic ERCP appears reasonably safe and effective in pregnancy. Cautious and selective use of this procedure offers a viable alternative to surgery or observation in patients with emergent pancreaticobiliary problems.
妊娠期胰胆疾病相对少见。据报道，妊娠期需要干预的胆总管结石症发生率低至每1200例分娩中有1例。传统上，对这些患者的干预手段是手术。虽然手术对孕妇的总体发病率和死亡率较低，但术后有4至6周的恢复期，且胎儿流产风险可能增加。关于内镜逆行胰胆管造影术（ERCP）在妊娠期的作用和安全性的公开信息有限。这组23例接受ERCP的孕妇是从6个不同的医疗中心收集的。
23例有症状的妊娠期胰胆疾病患者共接受了29次ERCP（3例患者接受诊断性ERCP，20例接受治疗性ERCP）。分别在孕早期、孕中期和孕晚期进行了15次、8次和6次操作。唯一的ERCP并发症是1例患者发生胰腺炎。有1例自然流产（ERCP术后3个月）和1例新生儿死亡；然而，与ERCP的因果关系并不明显。
诊断性和治疗性ERCP在妊娠期似乎相当安全有效。谨慎且有选择地使用该方法为有紧急胰胆问题的患者提供了一种可行的替代手术或观察的选择。
