儿童胆源性胰腺炎的临床特点

Clinical features of biliary pancreatitis in children

目的 探讨儿童胆源性胰腺炎的临床特点. 方法 回顾分析2011年1月至2015年7月儿童胆源性胰腺炎10例的临床资料. 结果 10例患儿中, 男2例、 女8例, 平均年龄 （6.1 ± 4.9） 岁, 平均住院天数 （8.4 ± 3.8） d. 胆囊结石4 例,胆汁淤积4例, 胆管结石2例, 胆总管囊肿2例, 胰腺分裂症1例. 10例患儿均以腹痛为主要临床表现.均有血淀粉酶升高,最高值106-922 U/L; 血脂肪酶升高6例, 为22-2 000 U/L; 血丙氨酸氨基转移酶异常6例, 低钾血症2例, 低血糖1例, 酸碱失衡4例.腹部B超提示4例有胰腺炎改变, CT则提示均有胰腺炎改变.予禁食、 补液、 维持水电解质平衡、 奥美拉唑抑制胃酸、 奥曲肽抑制胰酶分泌等治疗. 9例患儿内科保守治疗好转出院, 1例转外科手术治疗. 结论 儿童胆源性胰腺炎发病率低, 临床症状不典型, 小年龄患儿胰胆管系统畸形较多见, 内科保守治疗效果相对好.

Objective To explore the clinical characteristics of biliary pancreatitis in children. Methods The clinical data from 10 children with biliary pancreatitis from January 2011 to July 2015 were retrospectively analyzed. Result In 10 children （2 males and 8 females）, the average age was 6.1±4.9 years old, and the average hospital stay was 8.4±3.8 d. There were 4 cases of gallstone, 4 cases of cholestasis, 2 cases of calculus of bile duct, 2 cases of choledochocyst and 1 case of pancreatic divisum. Abdominal pain was the main clinical manifestation in these 10 children. All of them had elevated serum amylase, with the maximum value of 106-922 U/L. Six cases had elevated lipase of 22-2000 U/L. Six cases had abnormal serum alanine aminotransferase. Two cases had hypokalemia. One case had hypoglycemia. Four cases had acid-base imbalance. Abdominal ultrasonography showed pancreatitis in 4 cases. CT showed pancreatitis in all children. All of the children were treated by fasting, fuid infusion, maintaining water and electrolyte balance, inhibiting gastric acid by omeprazole and inhibiting pancreatic secretion by octreotide. Nine cases were improved by conservative treatment and discharged, and one case was transferred to surgery. Conclusion The incidence of biliary pancreatitis in children is low. The clinical manifestation is atypical. Pancreatic duct abnormalities are more common in young children, in whom the effect of conservative treatment is relatively good.