Clinical application of ultrasound guided percutaneous transhepatic gallbladder puncture and drainage in the treatment of pregnancy combined with acute biliary pancreatitis / 中国医师进修杂志

ABSTRACT

Objective:To investigate the clinical value and safety of ultrasound guided percutaneous transhepatic gallbladder puncture and drainage (PTGBD) in the treatment of pregnancy combined with acute biliary pancreatitis (ABP).Methods:The clinical data of 47 pregnant combined with ABP from 2010 to 2019 in Shengjing Hospital of China Medical University were retrospectively analyzed. Among them, 19 patients received regular medication (conservative group), and the other 28 patients received PTGBD (PTGBD group). Clinical indexes of two groups including acute physiology and chronic health evaluation acute physiology and chronic health evaluationⅡ(APACHEⅡ), serum amylase, white blood cell and total bilirubin were respectively recorded before and 3 days after treatment.Results:There were no statistical difference in the indexes before treatment between 2 groups ( P>0.05). The APACHE Ⅱ, serum amylase, white blood cell and total bilirubin after treatment were significantly lower compared with those before treatment, conservative group (5.9 ± 1.9) scores vs. (7.2 ± 1.3) scores, (736.8 ± 64.2) U/L vs. (969.2 ± 124.3) U/L, (10.3 ± 1.4) × 10 9/L vs. (14.7 ± 2.1) × 10 9/L and (55.3 ± 9.5) mmol/L vs. (67.1 ± 10.2) mmol/L; PTGBD group (4.1 ± 1.7) scores vs. (7.0 ± 1.2) scores, (465.5 ± 77.9) U/L vs. (1 001.8 ± 112.5) U/L, (8.4 ± 2.2) × 10 9/L vs. (13.5 ± 2.6) × 10 9/L and (38.4 ± 10.6) mmol/L vs. (73.7 ± 12.5) mmol/L, and the indexes in PTGBD group were statistically lower than those in conservative group, and there were statistical differences ( P<0.05). In conservative group, 5 cases died (both mother and infant) after deterioration of the condition and 1 infant died after birth. In PTGBD group, 3 cases died (both mother and infant) after deterioration of the condition and 1 infant died after birth. The maternal cure rate and fetal survival rate in PTGBD group were statistically higher than those in conservative group PTGBD 89.3% (25/28) vs. 14/19 and 85.7% (24/28) vs. 13/19, and there were statistical differences ( P<0.05). Conclusions:Among patients with pregnancy combined with ABP, early PTGBD is more effective than conservative medication, and quickly relieves symptoms and reduces complications.