胰胆管发育异常合并儿童胰腺炎21例临床分析

Clinical analysis of 21 cases of pancreaticobiliary malformation complicated with children’s pancreatitis

目的探讨胰胆管发育异常合并儿童胰腺炎的临床特点。方法选取中国医科大学附属盛京医院小儿消化内科2017年6月至2020年9月胰腺炎住院患儿175例,分两组:观察组为因胰胆管发育异常所致,21例;对照组为非胰胆管发育异常、非结石因素导致的胰腺炎154例。收集两组临床资料进行回顾性分析。结果胰腺炎中胰胆管发育异常发生率为12.0%,其中,观察组平均发病年龄(4.1±2.4)岁,略低于对照组(6.0±4.7)岁,差异无统计意义(P>0.05);观察组女性构成比为66.7%,明显高于对照组的51.3%,差异有统计学意义(P<0.05)。观察组谷氨酸氨基转移酶、门冬氨酸氨基转移酶、γ-谷氨酰基转移酶、血清总胆红素较对照组明显升高(P<0.01)。磁共振胰胆管造影(MRCP)对于胰胆管发育异常的阳性检出率最高,为89.5%。主要影像学表现为胰胆管合流异常、胰胆管先天变异、先天性胆管扩张症等。结论由胰胆管发育异常所致的儿童胰腺炎,发病年龄较小,且女性儿童多见。当胰腺炎患儿合并胆汁淤积、肝功能异常时应尽早行MRCP等影像学检查以提高胰胆管发育异常的检出率。内科治疗可暂时缓解症状,尽早行介入治疗或外科手术治疗可以改善预后。

Objective To investigate the clinical features pancreaticobiliary malformation complicated with children’s pancreatitis.Methods A total of 175 children with pancreatitis were included;21 hospitalized children with pancreatitis due to pancreaticobiliary malformation in the Department of Pediatric Gastroenterology,Shengjing Hospital were selected as the observation group,and 154 cases of pancreatitis caused by non developmental and noncalculous factors in the same period were included as control group.Their clinical data were collected for retrospective analysis.Results servation group was(4.1±2.4)years old,slightly lower than the control group(6.0±4.7)(P>0.05).The ratio of girls in the observation group was 66.7%,which was significantly higher than the control group(51.3%,P<0.05).In the observation group,glutamate aminotransferase,aspartate aminotransferase,γ-glutamyltransferase,and total serum bilirubin were significantly higher than those in the control group(P<0.01).MRCP had the highest positive detection rate(89.5%)for pancreaticobiliary malformation.The main imaging manifestations were pancreaticobiliary maljunction,congenital variation of pancreaticobiliary duct,and congenital biliary dilation.Conclusion dren caused by pancreaticbiliary malformation usually occurs in young children,and is more commonly seen in girls.When children with pancreatitis have cholestasis and abnormal liver function,imaging examinations such as MRCP should be performed as soon as possible to improve the detection rate of pancreaticobiliary malformation.Medical treatment can temporarily relieve symptoms,and treatment by intervention or surgical procedures should be performed as soon as possible to improve prognosis.