内镜诊治儿童胰腺分裂伴慢性胰腺炎的长期随访研究

A long-term follow-up of endoscopic diagnosis and treatment for pancreas divisum with chronic pancreatitis in children

目的评价经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)诊治儿童胰腺分裂(pancreas divisum,PD)伴慢性胰腺炎(chronic pancreatitis,CP)的安全性和有效性。方法回顾性分析2010年1月—2020年1月在浙江大学医学院附属杭州市第一人民医院行ERCP诊治的18周岁以下的PD伴CP患儿资料,详细记录患儿的一般资料、内镜下诊治情况、随访资料,并对比术前和术后胰腺炎发作次数、腹痛视觉模拟评分(visual analogue scale,VAS)、主胰管直径等指标。结果共计19例患儿确诊PD伴CP,总计实施82例次ERCP,平均每例4.31次(1~9次),每例患儿平均更换胰管支架3.21次(0~8次)。副乳头插管成功率为97.6%(80/82),首次ERCP术后腹痛缓解率为89.5%(17/19)。并发症发生率4.9%(4/82),无一例中转外科手术。平均随访55.8个月(9~114个月)。与术前比较,术后胰腺炎的中位发作次数由3.0次减少至0次(Z=-3.839,P<0.001),术后中位VAS由6分降低至1分(Z=-3.748,P<0.001)。而术前、术后中位胰管直径均为0.35 cm,差异无统计学意义(Z=-0.699,P=0.484)。结论ERCP诊治儿童PD伴CP安全有效。

Objective To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography(ERCP)for diagnosis and treatment of pancreas divisum(PD)combined with chronic pancreatitis(CP)in children.Methods Data of patients under 18 years old diagnosed as having PD with CP in Hangzhou First People′s Hospital from January 2010 to January 2020 were retrospectively analyzed.The general information,endoscopic procedures and follow-up of the children were recored.The number of acute pancreatitis attacks,visual analogue scale(VAS)scores of the abdominal pain,and the diameter of pancreatic duct before and after ERCP were compared.Results A total of 19 children diagnosed as having PD with CP underwent 82 ERCP procedures with the mean number of 4.31(1-9).The mean number of pancreatic stent replacement was 3.21(0-8).The success rate of minor papilla cannulation was 97.6%(80/82)with the pain relief rate of 89.5%(17/19)after the first ERCP.ERCP-related complication rate was 4.9%(4/82)without transference to surgery.The mean follow-up time was 55.8 months(9-114 months).The median number of acute pancreatitis attacks decreased from 3.0 to 0 compared with that before the procedure(Z=-3.839,P<0.001)and the median VAS score decreased from 6 to 1(Z=-3.748,P<0.001),both of which had significant difference.However,the median diameters of main pancreatic duct were both 0.35 cm before and after procedure with no significant difference(Z=-0.699,P=0.484).Conclusion ERCP is safe and effective to diagnose and treat pediatric patients with PD with CP.