培门冬酶化疗后胰腺假性囊肿6例分析

Pancreatic pseudocyst after pegaspargase treatment in six children

目的探讨儿童培门冬酶化疗后胰腺假性囊肿的临床特点及治疗方法。方法回顾性分析北京大学第三医院儿科2018年7月至2021年2月收治的6例培门冬酶化疗后胰腺假性囊肿患儿的病例资料,分析其临床特点及治疗方法。结果6例患儿中男4例、女2例,发病年龄9.5(5.8,13.0)岁,培门冬酶总使用次数为2.5(2.0,3.5)次,最后1次应用培门冬酶至出现胰腺炎时间为11.0(9.0,17.2)d,腹痛是胰腺炎最主要的表现(6例)。发生胰腺炎至发现胰腺假性囊肿的时间为42.5(35.0,129.5)d。6例患儿发现胰腺假性囊肿时均无临床症状,予保守治疗,有1例在保守治疗过程中出现间断进食后腹胀或恶心。6例患儿在保守治疗过程中均出现胰腺假性囊肿增大。有3例行超声内镜引导下经胃壁穿刺引流术,术后10 d至4个月囊肿消失;3例行经内镜逆行胰胆管造影(ERCP)经十二指肠乳头引流术,其中有1例因胰管狭窄引流未成功,行外科手术治疗,另外2例分别在术后1、3个月囊肿消失。有1例ERCP经十二指肠乳头引流患儿术后出现急性胰腺炎,对症治疗后好转,余5例未见并发症。结论儿童培门冬酶化疗后胰腺假性囊肿病程初期可能没有症状,要结合培门冬酶化疗史、影像学检查进行诊断,没有症状的假性囊肿首选保守治疗,保守治疗过程中出现假性囊肿增大,要根据囊肿与主胰管是否相通选择不同方式的内镜治疗。

Objective To investigate the clinical characteristics and treatment of pancreatic pseudocyst after pegaspargase treatment in children.Methods The clinical data of 6 children with pancreatic pseudocyst after pegaspargase treatment in the Department of Pediatrics in Peking University Third Hospital from July 2018 to February 2021 were analyzed retrospectively.Results There were 4 males and 2 females,and their age of onset was 9.5(5.8,13.0)years.The total number of pegaspargase applications was 2.5(2.0,3.5)times.The course from the last dose of pegaspargase to the onset of pancreatitis was 11.0(9.0,17.2)days,and 42.5(35.0,129.5)days from the onset of pancreatitis to the diagnosis of pancreatic pseudocyst.Abdominal pain was the most prominent manifestation of pancreatitis(6/6).All of the 6 children were asymptomatic when pancreatic pseudocyst was noted,and were treated conservatively at first,but one case later developed intermittent abdominal distension or nausea after eating.All the cases had pancreatic pseudocyst enlargement during the conservative treatment.Three children were treated with endoscopic ultrasound-guided transgastric drainage,and the cyst disappeared from 10 days to 4 months after the operation.The other 3 children received endoscopic retrograde cholangiopancreatography(ERCP)-guided transpapillary drainage,but one of them turned to surgery due to pancreatic duct stricture,and in the rest 2 children the cyst disappeared at 1 and 3 months after operation respectively.Regarding safety issues,1 child who received ERCP-guided transpapillary drainage had acute postoperative pancreatitis,which were improved after treatment,and the other 5 had no complications.Conclusions Pancreatic pseudocyst after pegaspargase chemotherapy can be asymptomatic in the early stage,and should be diagnosed with a history of pegaspargase treatment and timely imaging examination.Conservative treatment is the first choice for asymptomatic pseudocyst.When the pseudocyst enlarges,different endoscopic drainage treatments are required according to whether the pseudocyst is connected with the main pancreatic duct.