外引流治疗儿童胰腺假性囊肿疗效分析

Evaluation of percutaneous external drainage in treating pediatric pancreatic pseudocysts

目的探讨外引流治疗儿童胰腺假性囊肿的疗效与预后。方法收集2012年1月至2021年12月浙江大学医学院附属儿童医院收治的62例儿童胰腺假性囊肿临床资料,其中男27例,女35例;平均年龄为8.42岁,范围为5.50~11.29岁。诱发因素包括胰腺炎24例,胰腺外伤27例,白血病门冬酰胺酶化疗3例,胆源性胰腺炎3例,胰腺肿瘤术后5例。A组34例保守治疗,B组27例外引流治疗(腹腔镜外引流12例,超声引导下外引流12例,开腹外引流3例),1例男性患儿接受内引流治疗。对临床表现和疾病预后进行分析。结果A组囊肿最大横径中位数显著小于B组[5.00(3.35~7.30)cm比8.6(6.90~14.20)cm,P<0.001],A组囊肿平均消退时间显著长于B组[34.00(21.00~60.00)d比23.00(14.00~32.00)d,P=0.013]。A组治愈成功率73.5%(囊肿完全消退),治疗有效率85.3%(囊肿完全消退或囊肿显著缩小后无症状存在);B组治愈成功率88.9%,治疗有效率92.6%。结论无明显症状的小囊肿可行保守治疗;对于囊肿大、进展迅速且症状明显的患儿采用外引流治疗安全有效,能明显缩短治疗周期,无明显并发症。

Objective To investigate the efficacy and prognosis of percutaneous external drainage for pediatric pancreatic pseudocysts.Methods Sixty⁃two children diagnosed with pancreatic pseudocysts in The Children's Hospital,Zhejiang University School of Medicine were identified from January 2012 to December 2021.Among them,27 were male and 35 were female,the average age was 8.42 years(interquartile range:5.50~11.29 years).The inducing factors included pancreatitis(24 cases),pancreatic trauma(27 cases),leukemic asparaginase chemotherapy(3 cases),biliary pancreatitis(3 cases),and postoperative pancreatic tumor(5 cases).Thirty⁃four patients received conservative treatment(group A),27 received external drainage(group B,including laparoscopic external drainage in 12 cases,ultrasound⁃guided external drainage in 12 cases,open external drainage in 3 cases)and 1 male patient received internal drainage.A retrospective analysis was performed based on clinical manifestations and prognosis.Results The maximal transverse diameter of cysts in group B was significantly larger than that in group A[8.6(6.90⁃14.20)vs 5.00(3.35⁃7.30)cm,P<0.001],and the time of cystic regression in group B was significantly lower than that in group A[23.00(14.00⁃32.00)vs 34.00(21.00⁃60.00)days,P=0.013].In group A,the curative rate(pseudocysts disappeared completely)was 73.5%and effective treatment rate(pseudocysts disappeared completely or asymptomatic pseudocysts persisted)was 85.3%.In group B,the curative rate was 88.9%and effective treatment rate was 92.6%.Conclusion Conservative treatment is feasible for small asymptomatic pseudocysts;external drainage was safe and effective for large and symptomatic pseudocysts which can shorten the disease course with less complications.