儿童胰腺炎ERCP术后并发症研究

Complications of endoscopic retrograde cholangiopancreatography ( ERCP ) in children with pancreatitis

目的 分析儿童胰腺炎患者经内镜逆行胰胆管造影(endoscopic retrograde cholangiop-ancreatography,ERCP)术后高淀粉酶血症、胰腺炎及出血等并发症的发生率,探讨其安全性。方法 回顾分析1997年2月～2002年2月间入住我科确诊为儿童胰腺炎并行ERCP术的27例患者的临床资料,其中急性胰腺炎(acute pancreatitis,AP)14例,慢性胰腺炎(chronic pancreatitis,CP)13例;诊断性ERCP 9例,治疗性ERCP18例。结果 27例患者ERCP术后总体并发症发生率为51.85％(l4/27),其中,高淀粉酶血症发生率22.22％(6/27),术后4、24h血清淀粉酶水平分别为(410.75±230.31)U/L、(367.25±233.90)U/L,48～72h后均恢复正常;胰腺炎发生率22.22％(6/27),均为轻型胰腺炎;乳头切开处出血、黑便发生率7.41％(2/27),均发生于胆总管结石行十二指肠乳头括约肌切开(endoscopicsphincterotomy,EST)+取石术后;诊断性ERCP组并发症的发生率低于治疗性ERCP组,但无统计学意义。结论 儿童胰腺炎患者ERCP术后具有较高的并发症发生率,内镜医师于ERCP术中应高度重视,采取必要的预防措施以减少并发症的发生。

Objective To study the complications of endoscopic retrograde cholangiopancreato-graphy (ERCP) in children with pancreatitis. Methods 27 children with pancreatitis who had been treated with ERCP in Changhai Hospital from Feb 1997 to Feb 2002 were analyzed retrospectively. They included 9 boys and 18 girls ranging in age from 4 to 17 years (14. 81±2. 87). Of the 27 cases of pancreatitis, 14 were acute pancreatitis(AP) and 13 were chronic pancreatitis(CP). ERCP was simply diagnostic in 9 patients and therapeutic in 18. All ERCP procedures were performed by experienced endoscopists. Results The overall success rate was 100%. The overall ERCP related morbidity was 57. 98% (14/27), including hyperamylasemia in 6 cases (22. 22%), pancreatitis in 6 cases (22. 2%), and hemorrhage from papillosphincterotomy in 2 cases (7. 41%). The serum amylase levels in the hyperamylasemia cases were (410. 75 ± 230. 31) U/L and (367. 25± 233. 90) U/L at 4h and 24h after ERCP respectively. The incidence of hyperamylasemia, abdominal pain, pancreatitis was higher in the therapeutic group than in the diagnostic group, though there was no statistically significant difference (P>0. 05). Conclusions ERCP had a much higher complication rate in children than in adults, mostly associated with therapeutic procedures, and therefore more precautions should be given to pediatric patients in doing ERCP to decrease the potential adverse events.