治疗性内镜逆行胰胆管造影在儿童胰腺疾病中应用价值的初步探讨

Value of endoscopic retrograde cholangiopancreatography in the treatment of pancreatic diseases in children

目的回顾性分析治疗性内镜逆行胰胆管造影（ERCP）在12例儿童胰腺疾病患者中的疗效，以探讨ERCP在儿童胰腺疾病治疗中的应用价值。方法2007年至2013年共对12例患儿进行ERCP治疗，年龄10个月～13．3岁。患儿经B超、腹部CT及MRCP获得初步诊断，先行诊断性ERCP，确定诊断后据具体情况决定相应的治疗措施，如十二指肠乳头括约肌切开术、胰管括约肌切开、气囊扩张、内镜逆行胆管引流术、胰管支架引流术、内镜鼻胰管引流术。监测术后3、12、24h血常规和血淀粉酶，观察有无不适症状及腹部体征，判断有无ERCP术后高淀粉酶血症、胰腺炎、消化道出血、穿孔等并发症。长期随访患儿的进食排便情况、体质量、腹痛复发频率及程度，影像学检查了解胰腺、胰管情况。结果12例患儿诊断性ERCP均成功，共诊断出胆源性胰腺炎3例、胰腺分裂症2例、胰腺外伤2例、胰腺假性囊肿2例、慢性胰腺炎2例、胰管结石1例，并分别进行了个体化治疗。术后无一例发生消化道大出血、穿孔、重症胆道感染、死亡等严重并发症，无一例出现ERCP后胰腺炎。2例患儿出现高胰淀粉酶血症，经过保守治疗后好转出院。经过14～58个月随访，全部患儿症状缓解，治疗后体质量增长，定期复查肝功能及淀粉酶均位于正常范围，饮食及排便无异常者，身体发育及智力发育正常。结论对于一些儿童良性的胰腺疾病，治疗性ERCP是一种微创、可靠、安全有效的治疗方法，但对于原发病为胆管扩张症患儿的彻底治疗仍需要外科手术。

Objective To explore the therapeutic value of endoscopic retrograde cholangiopancreatography （ERCP） for pancreatic diseases in children. Methods A total of 12 children aged from 10 momhs to 13. 3 years underwent therapeutic ERCP from 2007 to 2013. Primary diagnosis was made by type B-ultrasound, computed tomography （CT） or magnetic resonance imaging （MRI） and confirmed with ERCP. According to individual conditions, the suitable therapeutic approaches were selected, such as EST （endoscopic sphincterotomy）, EPS （endoscopic pancreatic sphincterotomy）, EPBD （endoscopic papillary balloon dilation）, ERBD （endoscopic retrograde biliary drainage）, ERPD （endoscopic retrograde pancreatic drainage） and ENPD （endoscopic naso-pancreatic drainage）. The leukocyte count and the activities of blood amylase were monitored at 3 h, 12 h and 24 h post-ERCP. Results Among them, the definite diagnoses were acute biliary pancreatitis （n - 3）, pancreatic divisum （n = 2）, pancreatic injury （n = 2）, pancreatic pseudocyst （n = 2）, chronic panereatitis （n= 2） and pancreatic duct stone （n = 1）. No severe complications occurred, such as massive gastrointestinal hemorrhage, digestive tract perforation, severe biliary infection and death. Post-ERCP pancreatitis was not noted. Two cases of hyperamylasemia were cured through conservation treatment and discharged. After a follow-up period of 14 to 77 months, clinical symptoms alleviated and weight gained in all cases. Abnormal dietary and altered bowel habits were not found. Liver function and serum amylase were normal on regular reexaminations. The physiological and intelligential developments were normal in all cases. Conclusions Therapeutic ERCP is mini-invasive,reliable, safe and effective in the treatment for some benign pancreatic diseases in children. But surgery is still required for thoroughly understanding the basic pathological changes of congenital biliary dilatation.