内镜下逆行胰胆管造影术在儿童胰腺疾病中的应用分析

Analysis of clinical application of endoscopic retrograde cholangiopancreatography for the pancreatic diseases in children

目的 探讨内镜下逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）在儿童胰腺疾病中的应用价值、可行性及风险.方法 1994至2011年在杭州市第一人民医院消化内科住院,行ERCP诊治的14岁以下胰腺疾病患儿84例,其中男32例,女52例,平均年龄（11.03±2.05）岁,共行ERCP98例次.回顾分析本组患儿病因、ERCP麻醉方式、术中操作、疗效及术后并发症情况.结果 98例次接受ERCP检查的患儿中,急性胰腺炎32例次（其中胆源性胰腺炎30例次,高脂性胰腺炎2例次）,慢性胰腺炎42例次（其中胰管结石36例次,胰腺假性囊肿6例次）,胰腺分裂症20例次,胆胰管汇合异常6例次,环状胰腺1例次.分别完成胆、胰管开口切开、胆管取石、胰管取石,胆、胰管内支架置入,鼻胆管、鼻胰管引流等相关操作,治疗效果良好.其中,1例次（1％）出现术后切口出血,1例次（1％）术后胰腺炎,5例次（5％）术后高淀粉酶血症.并发症均于72 h内缓解.平均住院时间5.51 d.无ERCP相关死亡病例.结论 在设备及技术保障下,ERCP为儿童胰腺疾病安全有效的诊疗手段,与成人相比,并无更高的并发症.

Objective To study the feasibility and risk of endoscopic retrograde cholangiopancreatography （ERCP） for children in clinic,and to evaluate the effects of ERCP in diagnosis and treatment of the pancreatic diseases in children.Method Totally 98 patients under 14 years of age who underwent ERCP from 1994 to 2011 were enrolled in the study.The data of diagnosis,anesthesia type,treatments,and postoperative complications were collected.Result The 98 patients were 4 to 14 years old,of whom 32 cases suffered from acute pancreatitis （30 cases with biliary disease and 2 with hyperlipidemia） ;42 cases had chronic pancreatitis,of whom 36 had calculus of pancreatic duct,pancreatic pseudocyst was seen in 6 cases.Pancreas divisum was found in 20 cases,choledochopancreatic junction anomaly in 6 cases,and annular pancreas in 1 case.The operations of dissection of pancreatic duct and biliary duct,calculus removal,insertion of endoprosthesis and draining tube in pancreatic duct or biliary duct were performed.No patients died from ERCP complications.In observation of postoperative complications,acute pancreatitis after ERCP occurred in 1 case,with the incidence rate of 1 %,1 ease had bleeding（1%）,and 5 cases had hyperamylasemia （5%）.All the complications were cured within 1 week.The average hospital stay was 5.51 d.Conclusion ERCP is useful and safe in children under suitable condition of doctors and equipments,and no high rates of complications were observ ed.