ERCP在儿童胰胆管合流异常诊治中的应用价值

Application value of ERCP in the diagnosis and treatment of pancreaticobiliary maljunction in children

目的探讨ERCP在儿童胰胆管合流异常(PBM)诊治中的应用价值。方法回顾性分析2018年1月至2021年12月间南京医科大学附属儿童医院普外科行ERCP诊疗的77例PBM患儿的临床资料,总结PBM的临床特征、分型和术后护理措施,比较ERCP诊治前后患儿生命体征和生物化学指标变化,记录术后并发症发生情况。结果按照日本胆胰管合流异常研究组(JSGPM)分型,77例患儿中A型34例,B型18例,C型21例,D型4例。68例合并先天性胆管扩张,9例无胆管扩张。77例PBM患儿在全麻下行ERCP操作92例次,成功91例次,失败1例,操作成功率98.91%。ERCP诊疗术式包括乳头括约肌切开术7例次,乳头球囊扩张术28例次,探条扩张术22例次,网篮或球囊取石术22例次,逆行胆管支架引流35例次,胰管支架引流4例次,鼻胆管引流18例次,鼻胰管引流2例次,胆管支架取出术14例次。77例PBM患儿经ERCP治疗后,体温、FLACC评分、直接胆红素、血淀粉酶、丙氨酸转氨酶、天冬氨酸转氨酶、谷氨酰基转移酶等指标较术前明显下降,差异有统计学意义(P值均<0.001),术后并发症发生率为15.38%(14/91),其中高淀粉酶血症9例(9.89%),腹痛5例(5.49%)。结论ERCP在儿童胰胆管合流异常的治疗中是安全有效的。

Objective To investigate the application value of endoscopic retrograde cholangiopancreatography(ERCP)in the diagnosis and treatment of pancreaticobiliary maljunction(PBM)in children.Methods The clinical data of 77 PBM children who underwent ERCP in General Surgery Department of Childrens Hospital affiliated to Nanjing Medical University between January 2018 and December 2021 were retrospectively evaluated.Clinical characteristics,classification and post-operative nursing interventions were summarized,and vital signs,changes of biochemical markers and the occurrence of postoperative complications were compared and recorded.Results 77 patients were classified according to Japanese Study Group on Pancreaticobiliary Maljunction(JSGPM),including 34 patients with type A,18 patients with type B,21 patients with type C,and 4 patients with type D.There were 68 patients with congenital bile duct dilation and 9 patients without congenital bile duct dialtion.92 ERCP procedures were performed under general anesthesia,and 91 cases were successful with a success rate of 98.91%.Among these cases,including 7 cases of endoscopic sphincterotomy,28 cases of endoscopic balloon dilation of the nipple,22 cases of endoscopic probe dilation,22 cases of endoscopic stone removal by balloon or basket,35 cases of endoscopic retrograde biliary stent drainage,4 cases of endoscopic pancreatic duct drainage,18 cases of endoscopic nasobiliary drainage,2 cases of endoscopic nasobiliary drainage,and 14 cases of biliary stent removal.In 77 children with PBM,body temperature,FLACC score,and laboratory-related biochemical indexes including direct bilirubin,serum amylase,ALT,AST and CGT decreased significantly after ERCP,and all the differences were statistically significant(all P value<0.001).The incidence of postoperative complications was 15.38%(14/91),including hyperamylasemia in 9 cases(9.89%)and abdominal pain in 5 cases(5.49%).Conclusions ERCP is safe and effective in the treatment of abnormal confluence of pancreatic duct in children.