小儿慢性胰腺炎的外科治疗

SURGICAL MANAGEMENT OF CHRONIC PANCREATITIS IN CHILDREN

目的 探讨小儿慢性胰腺炎（CP）的外科治疗措施。方法 回顾性分析本院1996年1月～2005年12月收治的11例接受外科治疗的cP病例资料。结果 本组病例的临床症状以反复发作的上腹部疼痛为主。病因有胰管结石伴扩张3例，胰腺结构异常2例，胰管狭窄2例，胰管壶腹部狭窄1例、胆管扩张症并胰胆管合流异常2例、胆管下端狭窄1例。11例均接受手术治疗，术后10例患者（10／11）腹痛均明显缓解，无死亡病例。1例患儿因复发性胰腺炎再次住院2次，1例患儿术后发生胰漏，均保守治疗成功。结论 小儿CP的外科治疗应强调个体化原则。慢性胰腺炎外科治疗可延缓慢性胰腺炎的自然进程，对患儿的疾病转归至关重要。

Objective To investigated surgical managements of chronic pancreatitis in children. Methods Eleven cases of CP in children were retrospectively analyzed, who underwent surgical management at Ruijin Hospital, Shanghai Jiaotong University of Medical College, from January 1996 to December 2005. However, patients with pancreatic pseudocyst and CP resolved completely without surgical management were included in the present research. Results Among 11 Patients that involved surgical management, 8 of the patients were boys and 3 of the patients were girls, and their ages ranged from 7 to 16 years （at an average of 12 years old）. Time from symptom of pancreatitis after first onset till CP was definitely diagnosed was about 3 months to 6 years. Of the 11 patients, all patients presented with recurrent abdominal pain, 6 patients complained of weight loss, 2 steatorrhea, and 2 jaundice. Of the 11 patients received serum amylase, lipase with positive patients were 8/11 and 6/11, respectively. The positive diagnostic rate of B-ultrasound, computed tomography（CT）, endoscopic retrograde cholangiopancreatography （ERCP）, and magnetic resonance cholangiopan- creatography （MRCP） were 8/11,10/11,4/5, and 3/3, respectively. According to the imaging characteristics, 3 patients had pancreatic duct stones with dilation, 2 pancreatic structure abnormity, 2 pancreatic duct stenosis, 1 pancreatic ampullary stenosis, 2 congenital biliary dilation with pancreatico-biliary malunion, 1 pancreatic ampullary stenosis, 2 congenital biliary dilation with pancreaticobiliary malunion, and 1 distal stenosis of bile duct. All patients were referred for surgical management when medical therapy proved to be ineffctive. The operative approach was dictated by the results of imaging characteristics and surgical findings. Of the 11 Patients, 4 underwent distal pancreatectomy with Roux-en-Y pancreaticojejunostomy （Duval procedure）, 3 longitudinal pancreaticojejunostomy （modi- fied Puestow procedure）, 3 hepaticojejunostomy, 1 endoscopic pancreatic sphincterotomy （EPS）. All children survived, and 10 patients relieved abdominal pain postoperatively. 2 of the 11 patients suffered complications, pancreatic fistula and recurrent pancreatitis, respectively, but all cured by conservative treatments. Conclusions Surgical management of CP in children should be performed by individualized. Surgical management can postpone deterioration course of CP in children and allow resumption of a more normal lifestyle of children.