Barthel J S, Chowdhury T, Miedema B W
Division of Gastroenterology, Department of Medicine, MA-421, University of Missouri School of Medicine, Columbia, MO 65212, USA.
Surg Endosc. 1998 May;12(5):394-9. doi: 10.1007/s004649900689.
Gallstones are the most common cause of acute pancreatitis during pregnancy. Without intervention, gallstone pancreatitis during pregnancy is associated with an antepartum recurrence rate of 70%, which exposes the mother and fetus to an increased risk of morbidity and mortality. A safe, effective means to prevent recurrent gallstone pancreatitis during pregnancy is desirable.
Since 1991, we have managed gallstone pancreatitis in three pregnant patients with endoscopic retrograde cholangiogram (ERC), followed by spincterotomy, despite the absence of common bile duct stones.
All patients were judged to have mild pancreatitis by modified Ranson criteria and the Multiorgan System Failure criteria. During cholangiogram, fetal shielding was employed and fluoroscopy times ranged from 36 s to 7.2 min. One patient experienced postprocedure pancreatitis of 48-h duration. None of the patients experienced further episodes of pancreatitis and none underwent predelivery cholecystectomy.
In pregnancy-associated gallstone pancreatitis, endoscopic sphincterotomy prevents recurrence of pancreatitis and the need for cholecystectomy during gestation. We believe endoscopic sphincterotomy represents a promising management alternative for gallstone pancreatitis during pregnancy. Further investigation is warranted.
胆结石是孕期急性胰腺炎最常见的病因。若不进行干预，孕期胆结石性胰腺炎的产前复发率为70%，这会增加母亲和胎儿发病及死亡的风险。因此，需要一种安全、有效的方法来预防孕期复发性胆结石性胰腺炎。
自1991年以来，我们对3例孕期胆结石性胰腺炎患者进行了内镜逆行胆管造影（ERC），随后进行括约肌切开术，尽管未发现胆总管结石。
根据改良兰森标准和多器官系统衰竭标准，所有患者均被判定为轻度胰腺炎。在胆管造影过程中，采用了胎儿防护措施，透视时间为36秒至7.2分钟。1例患者术后出现了持续48小时的胰腺炎。所有患者均未再次发生胰腺炎，也均未在分娩前进行胆囊切除术。
在孕期相关性胆结石性胰腺炎中，内镜括约肌切开术可预防胰腺炎复发，并避免孕期进行胆囊切除术。我们认为内镜括约肌切开术是孕期胆结石性胰腺炎一种有前景的治疗选择。有必要进行进一步研究。
