ERCP对儿童胰腺炎的诊断与治疗价值

Diagnostic and therapeutic value of ERCP in children with pancreatitis

目的:探讨儿童胰腺炎ERCP的影像学特点及其对儿童胰腺炎的诊断、治疗价值。方法:回顾分析1997-02/2002-02间于我科行ERCP的27例儿童胰腺炎患者临床资料。其中,急性胰腺炎(acutepancreatitis,AP)14例,慢性胰腺炎(chronic pancreatitis,CP)13例。结果:诊断性ERCP 9例,治疗性ERCP 18例。CP组胆道疾病发病率7.7％,显著低于AP组95.7％(P<0.05):CP组原因不明占61.5％,显著高于AP组7.1％(P<0.05):ERCP特点:AP组胰管扩张发生率14.2％,显著低于CP组76.9％(P<0.01):AP组胆总管狭窄/扩张、胆总管结石发生率分别为49.7％、35.7％,显著高于CP组,CP组未见胆总管狭窄/扩张及胆总管结石:ERCP后高淀粉酶血症6例(22.2％),胰腺炎发作6例(22.2％),均为轻症胰腺炎,乳头切开处出血、黑便发生率7.4％(2/27),均发生于胆总管结石行十二指肠乳头括约肌切开(endoscopicsphincterotomy,EST)+取石术后:诊断性ERCP组并发症的发生率低于治疗性ERCP组,但无统计学意义。经6-68 mo随访,总体腹痛缓解率25/27(92.6％),2例复发者经再次ERCP治疗后腹痛未再出现。结论:胆道疾病可能是儿童急性胰腺炎主要病因,而慢性胰腺炎的病因不明:ERCP能有效地消除AP病因,缓解CP的腹痛症状:儿童患者ERCP后具有较高的并发症发生率,内镜医师对此应高度重视。

AIM: To explore the diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatography (ERCP) in children with pancreatitis. METHODS: 27 children with pancreatitis treated with ERCP from Feb 1997 to Feb 2002 were analyzed retrospectively. They included 9 boys and 18 girls ranging in age from 4 to 17years (14.8±2.9). Fourteen patients suffered from acute pancreatitis (AP) and thirteen from chronic pancreatitis (CP). RESULTS: Diagnostic ERCP was done in 9 patients and theraputic ERCP in 18. The ERCP findings were as follows: The morbidity of biliary tract disease was 7.7% in CP group, while it was 95.7% in AP group (P<0.05). 61.5% of CP group had no definite etiology, higher than the 7.1% in the AP group. ERCP showed that 76.9% had pancreatic duct dilatation in CP group, much higher than the 14.2% in AP group. The incidence of common bile duct stricture or/and dilatation, choledocholith were 49.7%, 35.7% respectively in AP group, while none in CP group. In the following 6 to 68 months after ERCP, 92.6% had no recurrent pancreatitis or abdominal pain. Affter a second ERCP inter- vention in 2 patients with recurrent abdominal pain, none had ahdominal pain any more. The overall ERCP related morbidity was 51.85%, including hyperamyiasemia in 6 cases (22.2%), pancreatitis in 6 (22.2%), and hemorrhage from papillosphincterotomy in 2 (7.4%). C0NCLUSION: Diagnostic and therapeutic ERCP had sig- nificant clinical improvement in children with pancreatitis, but had a much higher complication rate in children than In adults, mostly associated with therapeutic procedures. Therefore, more precautions should be given to pediatric patients in doing ERCP to decrease the adverse events.