儿童慢性胰腺炎的临床特点与内镜治疗

Clinical characteristics and endoscopic treatments of chronic pancreatitis in children

目的探讨儿童慢性胰腺炎的临床特点及内镜治疗方法。方法收集华中科技大学同济医学院附属武汉儿童医院普外科2020年8月至2022年6月治疗的12例慢性胰腺炎患儿的临床资料,其中男4例,女8例;平均年龄为9.46岁,范围在4.42~14.42岁。临床症状均以腹痛为主,无脂肪泻或糖尿病发生,生长发育基本正常,影像学多以胰管迂曲扩张、胰管结石等胰管改变为主要表现。12例慢性胰腺炎患儿中的11例行内镜逆行胰胆管造影术,1例因结石较大行外科手术治疗,共行内镜治疗20次,主要治疗方式为胰管支架置入,同时辅以十二指肠乳头切开或球囊扩张、胰管结石去除等以解除梗阻、保持胰液引流通畅,降低胰管内压力。结果12例慢性胰腺炎患儿中有7例存在遗传及先天性解剖变异,包括基因异常、胰腺分裂、胰胆管合流异常、环状胰腺等。其中3例临床症状完全缓解,随访超过1年无任何临床症状,余8例近期临床症状得到控制,仍在后续治疗中。术后胰腺炎1例,高淀粉酶血症2例,无出血、穿孔等并发症发生。结论儿童慢性胰腺炎病因与成人不同,多以遗传因素及解剖变异为主,内外分泌功能不足表现少见,磁共振胰胆管造影为儿童慢性胰腺炎的首选影像学检查方法,内镜逆行胰胆管造影术治疗儿童慢性胰腺炎安全有效。

Objective To explore the clinical characteristics and endoscopic treatments of chronic pancreatitis(CP)in children.Methods From August 2020 to June 2022,clinical data were retrospectively reviewed for 12 CP children.There were 4 boys and 8 girls with an average age of 9.46(4.42⁃14.42)years.The major clinical symptoms included abdominal pain without fatty diarrhea or diabetes,and growth and development were normal.The relevant imaging features were dilatation of pancreatic duct and pancreatic duct stone.Only 1 girl was operated due to the existence of large pancreatic duct stone while the remainders underwent endoscopic retrograde cholangiopancreatography(ERCP)for 20 times and 1.82 times per capita.The major treatment of pancreatic duct stenting was combined with endoscopic sphincterotomy(EST),endoscopic papillary balloon dilatation(EPBD)or pancreatic duct stone removal for relieving obstruction and lowering pressure in pancreatic duct.Results Among them,7 children had genetic and congenital anatomical abnormalities of pancreatic division,pancreaticobiliary maljunction and annular pancreas,etc.Three cases recovered completely and stayed symptom⁃free for more than 1 year while another 8 cases with recent clinical symptoms were controlled during follow⁃ups.There were postoperative pancreatitis(n=1)and hyperamylasemia(n=2).There was no such complications as hemorrhage or perforation.Conclusion The etiology of CP is different in children from that in adults.Genetic and congenital anatomical abnormalities predominate.MRCP is the preferred imaging examination.And ERCP is both safe and effective for CP in children.