儿童慢性胰腺炎的病因及内镜在治疗中的价值

Etiology of Chronic Pancreatitis in Children and Its Treatment with ERCP

目的探讨儿童慢性胰腺炎的病因和十二指肠镜在治疗中的价值。方法回顾性分析2006～2011年18例18岁以下因慢性胰腺炎行ERCP 40次的临床资料。年龄4～17岁,平均10.3岁。男8例,女10例,均存在上腹痛,影像学检查提示胰腺有异常表现。气管插管全麻下行ERCP。行狭窄括约肌切开、胰管狭窄段扩张、碎石、取石、胰管支架放置/鼻胰引流管放置等治疗。结果 18例40次ERCP操作,胰管插管成功39次(97.5%)。不明原因慢性胰腺炎11例(61.1%,其中2例以胰腺胸膜瘘发病),胰腺结构异常致慢性胰腺炎7例。全部患者症状消失。ERCP无严重并发症。9例结束治疗者随访1～39个月,均无腹痛发作。结论儿童慢性胰腺炎病因主要为特发性及结构异常,经十二指肠镜治疗微创、安全、有效。

Objective To investigate the causes of chronic pancreatitis in children and the value of duodenoscopy for the treatment. Methods An retrospective review on 18 children （10 girls and 8 boys, aged 4 to 17 years） with chronic pancreatitis, who underwent ERCP at our hospital between 2006 and 2011. The main clinical manifestation included epigastric pain and imaging suggesting abnormal pancreas. Under general anesthesia and tracheal cannulation, ERCP was performed. The therapeutic interventions included sphincterotomy, dilatation of the stenotic pancreatic duct, stone extraction, and stent insertion or naso-pancreatic drainage. Results A total of 40 ERCP procedures were performed on the 18 children, 39 of them （97.5%） were successful. In our patients, 11 cases were idiopathic pancreatitis （61.1% , 2 of them had pancreatic-pleural fistula） , 7 were caused by pancreatic divisum and 4 biliopancreatic malformation. The symptoms of pancreatitis disappeared after ERCP in all the patients, without any severe complications occurred. Nine of the patients received a follow-up for 1 to 39 months, during which none of them complained of abdominal pain. Conclusions The main causes of pancreatitis in children are idiopathic and biliopancreatic malformation, for which ERCP is a safe and effective approach.