儿童慢性胰腺炎29例临床分析

Clinical analysis of 29 cases of chronic pancreatitis in children

目的 探讨儿童慢性胰腺炎的病因及临床特征,以提高对本病的认识,尽早明确诊断,针对性治疗.方法 依据中华医学会消化内镜学分会2012年慢性胰腺炎临床诊断指南,回顾性分析2006年7月至2014年5月首都医科大学附属北京儿童医院住院治疗的29例慢性胰腺炎患儿的病因、临床表现、实验室检查、影像学检查及治疗等资料.结果 29例患儿中男19例,女10例;年龄2岁-15岁2个月[（8.5±3.7）岁].病因中以特发性胰腺炎为主（51.7％,15/29例）,其次为先天性解剖学异常（31.0％,9/29例）.主要临床表现为不同程度的腹痛26例（89.7％）;营养不良14例（48.3％）;恶心、呕吐9例（31.0％）;胸闷、喘憋5例（17.2％）.18例（62.1％）患儿血清淀粉酶水平升高.29例患儿行腹部B超发现胰腺病变28例（96.6％,28/29例）,胰管扩张或伴结石24例（82.8％,24/29例）.26例患儿行磁共振胰胆管造影（MRCP）显示胰腺形态饱满、萎缩、边缘不规则23例（88.5％,23/26例）,胰管扩张、扭曲21例（80.8％,21/26例）.6例10次行经内镜逆行性胰胆管造影术（ERCP）检查,发现胰管狭窄或扩张6例.29例患儿均先行内科保守治疗,7例行外科手术治疗（肝总管-空肠吻合术、胆总管十二指肠吻合术、胆总管囊肿切除术等）,行ERCP检查中6例均予胰管支架治疗.结论 儿童慢性胰腺炎的病因以特发性及结构异常为主;临床主要根据症状及影像学改变进行诊断;对于内科治疗效果不佳者可行外科手术或内镜下治疗.

Objective To investigate the etiology and clinical characteristics of chronic pancreatitis （CP） in children,so as to improve its diagnosis and treatment.Methods The etiology,clinical characteristics,radiological records and therapy were retrospectively analyzed in children with CP who were admitted to Beijing Children＇s Hospital Affiliated to Capital Medical University from July 2006 to May 2014.Results A total of 29 medical records of children with CP,including 19 male and 10 female,with a mean age of （8.5 ± 3.7） years,and the youngest case was a 2-year-old child,the oldest case was a 15-year-and-2-month-old child.The main etiological factor was idiopathic pancreatitis （51.7%,15/29 cases）,and 9 cases were caused by anatomical anomalies （31.0%,9/29 cases）.The main symptoms included abdominal pain （89.7%,26/29 cases）,malnutrition （48.3%,14/29 cases）,nausea and vomiting （31.0%,9/29 cases）,and chest distress and dyspnea （17.2%,5/29 cases）.The serum amylase level in 18 cases （62.1%） increased.The positive diagnostic rate of transabdominal ultrasound was 96.6% （28/29 cases）,and dilations of pancreatic ducts or/and intraductal stones were 82.8% （24/29 cases）.The positive rate by magnetic resonance cholangio-pancreatography （MRCP） for morphological changes in pancreas was 88.5% （23/26 cases）,and dilations of the pancreatic ducts were 80.8% （21/26 cases）.A total of 10 endoscopic retrograde cholangio-pancreatography （ERCP） procedures were performed on 6 children,and pancreatic ductal stenosis or dilations were detected in them.All the patients were treated conservatively at first,and then 7 cases of them had surgical therapy （oledochojejunostomy,choledochoduodenostomy,choledochocystectomy,etc.）,aud 6 cases had stent insertion by ERCP.Conclusions The main causes of CP in children are idiopathic and anatomical anomaly,and its diagnosis is based on symptoms and imaging changes;surgical or endoscopic therapy can be used if internal therapy is not effective.