儿童及青少年胰腺分裂伴急性复发性胰腺炎的内镜诊治分析
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Endoscopic diagnosis and treatment of pancreas divisum with recurrent acute pancreatitis in children and teenagers
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    摘要:

    目的 评价经内镜逆行胰胆管造影术(ERCP)诊治儿童及青少年胰腺分裂(PD)伴急性复发性胰腺炎(RAP)的安全性及效果。方法 2011年1月至2015年1月,经ERCP明确RAP型症状性PD诊断,并行内镜下副乳头括约肌切开联合副胰管支架置入术(ESCS)及主副乳头双括约肌切开联合副胰管支架置入术(Bi-ESCS)治疗,年龄在18周岁以下的9例患儿纳入回顾性分析,汇总诊治完成情况、并发症发生情况以及随访结果。结果 9例均为首次确诊,共行18例次治疗性ERCP,副胰管插管成功率为100.0%(18/18)。并发症发生率为11.1%(2/18),均较轻微,包括术后轻型胰腺炎和高淀粉酶血症各1例次。随访3~60个月,9例术后腹痛均获得改善(其中7例未再出现腹痛或复发胰腺炎),复查MRCP、CT等均未见胰管扩张,患儿体重增加,身体及智力发育正常。结论 ERCP可明确RAP型症状性PD诊断,还可采用ESCS及Bi-ESCS技术对确诊的儿童及青少年患儿进行安全和有效的治疗。

    Abstract:

    Objective To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis and treatment of pancreas divisum(PD) associated with recurrent acute pancreatitis(RAP) in children and teenagers. Methods Data of patients with symptomatic PD associated with RAP under 18 years old who were diagnosed and treated with ERCP from January 2011 to January 2015 were retrospectively analyzed. Patients with complete pancreas divisum underwent endoscopic minor sphincterotomy combined with dorsal duct stenting(ESCS), and those with incomplete pancreas divisum underwent bi-papilla endoscopic sphincterotomy combined with dorsal duct stenting(Bi-ESCS). ERCP-related data, complications were recorded. Long-term follow-up was conducted for procedure related complications. Results Nine patients with symptomatic PD associated with RAP were firstly diagnosed. A total of 18 ERCP procedures were performed in these patients, with success rate of 100.0% (18/18) in the minor papilla cannulation, and mild ERCP-related complication rate of 11.1% (2/18). One was acute mild pancreatitis and the other was hyperamylasemia. During follow-up from 3 to 60 months, all patients had pain relief, among whom 7 were asymptomatic, with no onset of acute pancreatitis. Dorsal ducts of all patients were not obviously dilated in MRCP or CT scan. All patients gained weight and presented normal physical and intelligence development. Conclusion Symptomatic PD associated with RAP can be completely diagnosed with ERCP. ESCS and Bi-ESCS are safe and effective endoscopic treatment techniques for pediatric cases.

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崔光星,杨建锋,金杭斌,等.儿童及青少年胰腺分裂伴急性复发性胰腺炎的内镜诊治分析[J].中华消化内镜杂志,2017,34(2):104-107.

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  • 在线发布日期: 2017-04-26
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