儿童胰周积液内镜下经胃壁穿刺引流5例并文献复习

Endoscopic drainage of peripancreatic fluid collection through gastric wall:a report of 5 children with a literature review

目的探讨儿童胰周积液内镜下经胃壁穿刺引流的临床效果。方法回顾性分析复旦大学附属儿科医院2019年3月至2022年3月5例胰周积液患儿行内镜下经胃壁穿刺引流的相关资料,其中男1例,女4例;中位发病年龄8岁;淋巴瘤培门冬酶化疗后2例,外伤2例,胰腺病损切除术后1例;CT下囊肿中位直径9.6 cm。分析其临床特征,手术方式及预后。检索截至2022年6月1日中国知网、万方医学数据库、PubMed及Embase数据库中关于儿童胰周积液的相关文献并进行复习。结果5例患儿中,2例因外伤致胰管不同程度断裂行内镜下逆行胰胆管造影放置胰管支架,放置支架失败予以同时行内镜下经胃壁穿刺并放置鼻胆管引流;2例经胃镜下穿刺放置鼻胆管引流;1例患儿胃镜下放置双猪尾支架引流。5例患儿术后1个月随访B型超声提示囊肿均明显缩小或消失。1例患儿胰腺假性囊肿复发行开放手术,余4例患儿规律随访无明显手术并发症。通过文献检索,发现相关文献14篇共65例患儿内镜下经胃壁或十二指肠壁穿刺引流治疗胰周积液,手术操作成功率为93.8%(61/65),因并发症再手术率为12.3%(8/65),再次手术首要原因为支架堵塞(5/8)。结论儿童胰周积液在内镜下经胃壁穿刺引流是一种安全有效的选择,经胃壁留置鼻囊管外引流可获得较好的治疗效果,部分患儿需要多种治疗方式配合。

Objective To explore the clinical efficacy of endoscopic drainage of peripancreatic fluid collection(PFC)through gastric wall in children.Methods From March 2019 to March 2022,the relevant clinical data were retrospectively reviewed for 5 children undergoing endoscopic transgastric peripancreatic fluid drainage.Clinical profiles,treatments and outcomes were recorded.And the related literatures were retrieved from the databases of CNKI,Wanfang,PubMed and Embase until June 1st,2022.Results There were 1 boy and 4 girls with a median age of 8 years.There were lymphoma after asparaginase chemotherapy(n=2),trauma(n=2),and complications of pancreatic tumor resection(n=1).Median diameter of cyst was 9.1(6.8-9.8)cm on computed tomography(CT).There were nasocystal drainage(n=2),bile duct stent drainage(n=2)and ERCP pancreatic duct papillary drainage(n=1).Moreover,1 child was re-operated due to a recurrence of pancreatic cyst.Postoperative follow-up CT was performed.Position of drainage catheter was normal.Five cases of cysts decreased or disappeared to varying degrees after operation.And 4 children had a marked relief without obvious surgical complications.Through literature searching,14 articles of endoscopic treatment of peripancreatic effusion were retrieved,including 65 children with peripancreatic effusion undergoing endoscopic incision and drainage through gastric or duodenal wall.Success rate of operation was 93.8%(61/65)and rate of reoperation due to complications 12.3%(8/65).A major cause for reoperation was stent blockage(5/8).Conclusions External drainage of PFC through gastric wall under gastroscopy or duodenoscopy is both safe and effective.Some cases require a variety of drainage modes.