背景:胆总管囊肿(CC)是胆道的囊性扩张,通常在童年时期被诊断出来,在一般人群中估计发病率为1:100000。与CC相关的并发症包括破裂,胆道梗阻,和胆管炎.很少报道孕妇在怀孕期间的CC,也没有关于优化管理的指导方针。
目的:系统回顾在妊娠或产后诊断出的孕妇CC的临床表现,治疗和分娩方式,和产妇结局。
方法:使用MEDLINE/PubMed对妊娠和产后孕妇CC的病例和病例系列进行了文献检索,WebofScience,谷歌学者,和Embase。语言或出版年份没有限制。最后一次访问数据库是在2022年9月1日。
结果:总体而言,71份出版物符合纳入标准,报告97例。怀孕期间诊断出88例,产褥期诊断出9例。最常见的症状是腹痛(81.2%)和黄疸(60.4%)。52.5%的病例需要对CC并发症进行干预,34%的妊娠是诱导的。紧急剖宫产(CS)占24.7%。孕产妇死亡率为7.2%,而胎儿死亡率报告不一致。胆管炎,CC>15cm,胆红素水平>80mmol/L与紧急CS和CC手术干预的可能性较高相关。胆红素水平与CC大小呈正相关。年龄与囊肿大小无相关性,囊肿发现时的胎龄,和CC大小。
结论:虽然罕见,妊娠合并上腹痛的黄疸评估中应包括孕妇CC.症状和临床过程是可变的,治疗可能从预期方法到紧急手术CC治疗和紧急CS。虽然大多数病例是通过保守的措施或引流程序来管理的,CC>15cm和进行性胆管炎携带CC破裂和脓毒症并发症的风险,这可能会增加不良母婴结局的发生率。因此,这种情况需要特定的手术和产科干预。
BACKGROUND: Choledochal cysts (CC) are cystic dilatations of the biliary tract, usually diagnosed during childhood, with an estimated incidence in the general population of 1:100000. Complications related to CC include rupture, biliary obstruction, and
cholangitis. Maternal CC in pregnancy are rarely reported, and there are no guidelines on optimal management.
OBJECTIVE: To systematically
review maternal CC diagnosed during pregnancy or postpartum with regard to the clinical presentation of CC, the mode of treatment and delivery, and maternal outcomes.
METHODS: A literature search of cases and case series of maternal CC in pregnancy and postpartum was conducted using MEDLINE/PubMed, Web of Science, Google Scholar, and Embase. There were no restrictions on language or publication year. Databases were lastly accessed on September 1, 2022.
RESULTS: Overall, 71 publications met the inclusion criteria, reporting 97 cases. Eighty-eight cases were diagnosed during pregnancy and nine in the puerperium. The most common symptoms were abdominal pain (81.2%) and jaundice (60.4%). Interventions for CC complications were required in 52.5% of the cases, and 34% of pregnancies were induced. Urgent cesarean section (CS) was done in 24.7%. The maternal mortality was 7.2%, while fetal mortality was inconsistently reported.
Cholangitis, CC > 15 cm, and bilirubin levels > 80 mmol/L were associated with a higher likelihood of urgent CS and surgical intervention for CC. Bilirubin levels positively correlated with CC size. There was no correlation between age and cyst dimension, gestational age at cyst discovery, and CC size.
CONCLUSIONS: Although rare, maternal CC in pregnancy should be included in the evaluation of jaundice with upper abdominal pain. Symptomatology and clinical course are variable, and treatment may range from an expectative approach to emergent surgical CC treatment and urgent CS. While most cases were managed by conservative measures or drainage procedures, CC > 15 cm and progressive
cholangitis carry the risk of CC rupture and septic complications, which may increase the rates of unfavorable maternal and fetal outcomes. Therefore, such cases require specific surgical and obstetric interventions.