儿童和青少年慢性胰腺炎患者临床特征及内镜诊治效果分析

Clinical features of chronic pancreatitis and clinical value of endoscopic retrograde cholangiopancre- atography for pediatric population

目的评价儿童及青少年（≤17岁）慢性胰腺炎患儿行经内镜逆行胰胆管造影术（ERCP）诊治的临床价值和安全性。方法回顾性收集2008年1月1日至2014年4月30日上海交通大学医学院附属瑞金医院消化内镜中心行ERCP诊治的87例儿童和青少年慢性胰腺炎患儿（2～17岁）的临床资料，按年龄段分成3组，2～6岁（幼儿组，n=27）、7～12岁（少年儿童组，n=35）、13～17岁（青少年组，n=25），统计分析各组内镜诊治情况及并发症发生情况。结果87例患儿共行170例次ERCP诊治，ERCP操作总成功率为99．4％（169／170），均经ERCP明确诊断为慢性胰腺炎。ERCP操作成功率幼儿组为97．6％（40／41），少年儿童组为100．0％（72／72），青少年组亦为100．0％（57／57），3组间差异无统计学意义（P=0．207）。3组均无出血、穿孔等严重并发症，亦均无操作相关死亡病例，ERCP术后并发症总发生率幼儿组、少年儿童组和青少年组分别为41．5％（17／41）、25．0％（18／72）和24．6％（14／57），幼儿组的术后并发症总发生率明显高于少年儿童组（P=0．039）和青少年组（P=0．045）。结论儿童和青少年慢性胰腺炎患儿行ERCP诊治是安全和有效的，但年龄小的慢性胰腺炎患儿发生ERCP术后并发症的风险可能更高。

Objective To study the clinical value and the safety of endoscopic retrograde cholangio- pancreatography（ERCP） for chronic pancreatitis in the pediatric population. Methods Clinical data, endo- scopic reports, and radiography of chronic pancreatic patients aged from 2 to 17 years old who underwent ERCP between Jan. 1,2008 and Apr. 30,2014 at Endoscopy Center of Ruijin Hospital were reviewed. These patients were divided into 3 groups, patients aged from 2 to 6 years old as children group（n =27）, patients aged from 7 to 12 years old as juvenile group（n =35） and patients aged from 13 to 17 as adolescent group（n =25）. Their clinical data and complications were analyzed by groups. Results A total of 170 ERCP procedures were performed in 87 patients, with the success rate of 99.4% （169/170）. All patients were diagnosed as having chronic pancreatitis by ERCP. Success rates of children group, juvenile group and adolescent group were 97. 6% （40/41）, 100. 0% （72/72） and 100. 0% （ 57/57 ） respectively. There was no statistically significance among the three groups （P = 0. 207 ）. No serious complications like bleeding or perforation occurred. No proce- dure-related mortality occurred in this study either. The rate of post-ERCP adverse events in children group, juvenile group and adolescent group were 41.5% （ 17/41 ）, 25.0% （18/72） and 24. 6% （ 14/57）, respective- ly. Children group had more adverse events than the juvenile group （P = 0. 039 ） and adolescent group （P =0. 045）. Conclusion Pediatric ERCP is highly effective in the pediatric population with chronic pancreatitis.The incidence of post ERCP adverse events is higher among the youngest children.