儿童经内镜逆行胰胆管造影术有效性和安全性分析

Efficacy and safety of endoscopic retrograde cholangiopancreatography in children

目的探讨经内镜逆行胰胆管造影术(ERCP)在儿童胆胰疾病诊疗中的有效性及安全性。方法回顾性分析2007年1月至2021年7月因胆胰疾病在南昌大学第一附属医院就诊并接受ERCP的127例患儿的临床资料,根据患儿所患疾病分为胆道疾病组及胰腺疾病组,分别统计ERCP操作次数、技术成功率、诊断、干预措施及术后并发症等情况,并分析ERCP术后胰腺炎(PEP)的危险因素。组间比较采用t检验或χ^(2)检验,危险因素分析采用多因素Logistic回归。结果127例患儿中男54例、女73例,首次行ERCP的中位年龄14岁,共接受ERCP治疗181例次,成功率98.3%(178/181)。术前影像学检查中B超、CT及磁共振胰胆管成像(MRCP)对儿童胆胰疾病的诊断阳性率分别为54.1%(53/98)、56.1%(37/66)、79.3%(88/111),3种检测诊断阳性率差异有统计学意义(χ^(2)=17.33,P<0.001)。胆道和胰腺疾病行ERCP最常见适应证分别为胆总管结石(77.0%,107/139)和胰腺先天结构异常(31.0%,13/42)。ERCP术后患儿腹痛明显缓解,肝功能指标均显著改善(均P<0.001),胰腺疾病组患儿术后较术前血淀粉酶水平显著下降(t=7.73,P<0.001)。ERCP术后总体并发症发生率为12.2%(22/181),其中以PEP发生率最高(7.2%,13/181),胰腺组PEP的发生率高于胆道组,差异有统计学意义[16.7%(7/42)比4.3%(6/139),χ^(2)=7.38,P=0.007]。多因素Logistic回归分析显示年龄小是PEP的独立危险因素(OR=0.80,95%CI 0.67~0.96)。结论MRCP是儿童胆胰疾病首选的影像学检查。儿童ERCP操作技术成功率高,对胆胰疾病的缓解作用明显,可以安全有效地应用于儿童胆胰疾病的诊疗。

Objective To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography(ERCP)in the diagnosis and treatment of biliary and pancreatic diseases in children.Methods The clinical data of 127 children who were treated with ERCP in the First Affiliated Hospital of Nanchang University from January 2007 to July 2021 were analyzed.According to the diseases they suffered from,the children were divided into biliary group and pancreatic group.The operation times,technical success rate,diagnosis,interventions and post-ERCP complications between the groups were compared by t-test or χ^(2) test.The risk factors of post-ERCP pancreatitis(PEP)were analyzed by multivariate Logistic regression.Results A total of 127 children,including 54 males and 73 females,with a median age of 14 years at first ERCP,were included in this study.ERCP was performed in 181 cases,with a success rate of 98.3%(178/181).In pre-ERCP imaging examination,the positive diagnostic rates of ultrasound,CT and magnetic resonance cholangiopancreatography(MRCP)for biliary and pancreatic diseases were 54.1%(53/98),56.1%(37/66)and 79.3%(88/111),respectively.MRCP had the highest positive diagnostic rate,and the difference among the three measures was statistically significant(χ^(2)=17.33,P<0.001).The most common indications for ERCP in biliary and pancreatic diseases were choledocholithiasis(77.0%,107/139)and congenital structural abnormalities of the pancreas(31.0%,13/42),respectively.After ERCP,the abdominal pain was dramatically relieved and the liver function was significantly improved(all P<0.001).The blood amylase level of the children with pancreatic diseases was significantly lower than that before ERCP(t=7.73,P<0.001).The overall incidence of post-ERCP complications was 12.2%(22/181),of which post-ERCP pancreatitis(PEP)was the most common(7.2%,13/181).The incidence of PEP was significantly higher in the pancreatic group than in the biliary group(16.7%(7/42)vs.4.3%(6/139),χ^(2)=7.38,P=0.007).Multivariate Logistic regression analysis showed that young age was the independent risk factor of PEP(OR=0.80,95%CI 0.67-0.96).Conclusions MRCP is the first choice for pre-ERCP imaging examination of biliary and pancreatic diseases in children.ERCP can be safely and effectively used in the diagnosis and treatment of biliary and pancreatic diseases in children,with a high success rate and obvious alleviation of symptoms.