小儿胆总管囊肿合并急性胰腺炎的临床特点分析

Clinical features of choledochal cyst plus acute pancreatitis in children

目的比较胆总管囊肿合并急性胰腺炎患儿与不合并胰腺炎患儿的临床特点。方法回顾性分析2018年1月至2021年12月华中科技大学同济医学院附属武汉儿童医院收治的137例胆总管囊肿患儿临床资料,其中男30例,女107例,中位年龄3.00(0.02~12.75)岁,统计Todani分型、胆总管扩张类型以及实验室检查结果。使用Fisher精确检验、卡方检验和Wilcoxon检验方法对结果进行统计学分析。结果137例胆总管囊肿患儿中,Ⅰa型占67.15%(92/137),Ⅰc型占29.20%(40/137),Ⅳa型占3.65%(5/137)。胆总管囊形扩张占69.34%(95/137),梭形扩张占30.66%(42/137)。47.45%(65/137)的患儿合并有急性胰腺炎,52.55%(72/137)的患儿没有合并急性胰腺炎。与没有合并急性胰腺炎的患儿相比,胆总管囊肿合并急性胰腺炎在年龄偏大的患儿中更易发生(3.42岁比2.42岁,P=0.010);男患儿相比于女患儿更容易发生(30.77%比13.89%,P=0.023);胆总管梭形扩张比囊形扩张更多(41.54%比20.83%,P=0.010);合并有胰胆管汇合异常的患儿明显容易更多(78.57%比21.05%,P=0.002)。Todani分型与急性胰腺炎之间相关性无统计学意义(P=0.668)。胆总管囊肿的患儿中,合并急性胰腺炎患儿的总胆红素、丙氨酸转氨酶、天冬氨酸转氨酶、C反应蛋白均高于没有合并急性胰腺炎的患儿。结论与不合并急性胰腺炎的患儿相比,胆总管囊肿合并急性胰腺炎易在男患儿中发生,囊肿易呈梭形扩张,且更易合并胰胆管汇合异常。

ObjectiveTo explore the clinical features of children with choledochal cysts(CC)plus acute pancreatitis(AP).MethodsFrom January 2018 to December 2021,the relevant clinical data were retrospectively reviewed for 137 CC children.There were 30 boys and 107 girls with a median age of 3(0.02-12.75)years.Statistics results of Todani's typing,dilation type of common bile duct(CBD)and laboratory tests were recorded.Fisher's exact,chi-square and Wilcoxon tests were performed.ResultsAmong them,typeⅠa accounted for 67.15%(92/137),typeⅠc 29.20%(40/137)and typeⅣa 3.65%(5/137).Cystic dilatation of CBD was detected in 69.34%(95/137)and fusiform dilatation in 30.66%(42/137).AP concurred in 47.45%(65/137)of children with CC and 52.55%(72/137)of children without concurrent AP.Compared to those without concurrent AP,CC children with AP was more prone to occur in elders(3.42 vs 2.75 year,P=0.010),males(30.77%vs 13.89%,P=0.023),usiform dilatation of CBD(41.54%vs 20.83%,P=0.010)and concurrent pancreaticobiliary maljunction(78.57%vs 21.05%,P=0.002).No statistically significant correlation existed between Todani's typing and AP(P=0.668).CC patients with AP had higher levels of total bilirubin,alanine aminotransferase,aspartate aminotransferase and C-reactive protein than those without AP.ConclusionIn CC patients,AP occurs frequently,especially in males and those with fusiform dilatation and associated pancreaticobiliary maljunction.Surgery should be performed as early as possible.