先天性胆道扩张症术后损伤性胰腺炎的控制

Treatment of Traumatic Pancreatitis after Hepaticoenterostomy in Congenital Biliary Dilatation

目的分析胆道扩张症术后发生胰腺炎的原因,探讨减少术后损伤性胰腺炎发生的控制措施。方法总结2010年7月—2014年3月贵阳市儿童医院22例先天性胆道扩张症患者资料,男8例,女14例;年龄6个月~6岁零9个月。其中8例发生术后损伤性胰腺炎者为研究组,余14例未发生者为对照组。均行扩张胆总管切除、肝总管-空肠Roux-en-Y吻合术。全部患儿术后均获定期门诊及电话随访,随访时间为3个月~3年,对随访的患儿进行全面体检,常规检查血、尿淀粉酶,了解其变化,B超检查了解胰腺恢复情况以及肝内、外胆管扩张情况。结果22例中8例术后1、4 d血淀粉酶,1、4、7 d尿淀粉酶较其余14例明显升高（P〈0.05）,同时伴低热,白细胞增高,考虑为术后损伤性胰腺炎,经使用胰酶抑制剂以及抗炎治疗4~9 d天恢复正常。全部患儿随访生长发育良好,2例转氨酶偶有升高,后逐渐好转,无胰腺炎、逆行性胆管炎发作患儿。B超检查未见肝内、外胆管扩张情况。结论先天性胆道扩张症患儿早期接受囊肿切除、肝总管-空肠Roux-en-Y吻合术,术中仔细操作,注意囊肿减压,中断胰胆管合流,术后配合胰酶抑制剂治疗,可降低术后损伤性胰腺炎发生。

Objective To investigate the cause of postoperative pancreatitis in Congenital Biliary Dilatation（CBD）,and to explore the preventive measures to decrease its occurrence. Methods Patients with CBD（n=22） were summarizedduring July 2010- March 2014 in Guiyang children＇s hospital, which include 8 cases of male, 14 cases of female; Cases thatdeveloped postoperative traumatic pancreatitis were taken as experimental group. Cases that did not developed it was used ascontrol group. Ages are from 6 months old to 6 years and 9 months old. All patients were received cyst excision and hepaticduct-jejunum Roux- en- Y anastomosis. All postoperative patients are followed up regularly in clinic and by telephone.All followed up were from 3 months to 3 years with a comprehensive physical examination, routine blood test and urine amy-lase analysis. B- ultrasonic examination was used to understand pancreas recovery as well as the expansion of bile duct inthe liver. Results Among the 22 cases, the postoperative 1stand 4thday blood amylase as well as 1st,4thand 7thday urineamylase in the experimental group are all higher than those in the control group with statistical difference（P〈0.05）.Patients in experiment group show low thermal and high leucocyte represent postoperative traumatic pancreatitis. All pa-tients were given trypsin inhibitor and anti-inflammatory treatment who were completely recovered after 4-9 days. All chil-dren growth developed normally, with only 2 cases of raised transaminase which were finally settled. Children showed no pan-creatitis and their ascending cholangitis, upper gastrointestinal angiography revealed no reflux gastritis. Conclusion Thepatients with CBD should receive surgery-cyst excision, hepatic duct-jejunum Roux-en-Y anastomosis early. During opera-tion, cysts decompression should be applied early. Besides these two procedures, interrupting pancreatic confluence and treat-ing pancreatic enzyme inhibitors postoperative can both help to decrease the occurrence of postoperative traumatic pancreatitis.