CAJ | 학술논문

目的探讨儿童慢性胰腺炎的病因及临床特征,以提高对本病的认识,尽早明确诊断,针对性治疗.方法依据中华医学会消化内镜学分会2012年慢性胰腺炎临床诊断指南,回顾性分析2006年7月至2014年5月首都医科大学附属北京儿童医院住院治疗的29例慢性胰腺炎患儿的病因、临床表现、实验室检查、影像学检查及治疗等资料.结果 29例患儿中男19例,女10例;年龄2岁～15岁2个月[(8.5±3.7)岁].病因中以特发性胰腺炎为主(51.7％,15/29例),其次为先天性解剖学异常(31.0％,9/29例).主要临床表现为不同程度的腹痛26例(89.7％);营养不良14例(48.3％);恶心、呕吐9例(31.0％);胸闷、喘憋5例(17.2％).18例(62.1％)患儿血清淀粉酶水平升高.29例患儿行腹部B超发现胰腺病变28例(96.6％,28/29例),胰管扩张或伴结石24例(82.8％,24/29例).26例患儿行磁共振胰胆管造影(MRCP)显示胰腺形态饱满、萎缩、边缘不规则23例(88.5％,23/26例),胰管扩张、扭曲21例(80.8％,21/26例).6例10次行经内镜逆行性胰胆管造影术(ERCP)检查,发现胰管狭窄或扩张6例.29例患儿均先行内科保守治疗,7例行外科手术治疗(肝总管-空肠吻合术、胆总管十二指肠吻合术、胆总管囊肿切除术等),行ERCP检查中6例均予胰管支架治疗.结论儿童慢性胰腺炎的病因以特发性及结构异常为主;临床主要根据症状及影像学改变进行诊断;对于内科治疗效果不佳者可行外科手术或内镜下治疗.
목적 탐토인동만성이선염적병인급림상특정,이제고대본병적인식,진조명학진단,침대성치료.방법 의거중화의학회소화내경학분회2012년만성이선염림상진단지남,회고성분석2006년7월지2014년5월수도의과대학부속북경인동의원주원치료적29례만성이선염환인적병인、림상표현、실험실검사、영상학검사급치료등자료.결과 29례환인중남19례,녀10례;년령2세～15세2개월[(8.5±3.7)세].병인중이특발성이선염위주(51.7％,15/29례),기차위선천성해부학이상(31.0％,9/29례).주요림상표현위불동정도적복통26례(89.7％);영양불량14례(48.3％);악심、구토9례(31.0％);흉민、천별5례(17.2％).18례(62.1％)환인혈청정분매수평승고.29례환인행복부B초발현이선병변28례(96.6％,28/29례),이관확장혹반결석24례(82.8％,24/29례).26례환인행자공진이담관조영(MRCP)현시이선형태포만、위축、변연불규칙23례(88.5％,23/26례),이관확장、뉴곡21례(80.8％,21/26례).6례10차행경내경역행성이담관조영술(ERCP)검사,발현이관협착혹확장6례.29례환인균선행내과보수치료,7례행외과수술치료(간총관-공장문합술、담총관십이지장문합술、담총관낭종절제술등),행ERCP검사중6례균여이관지가치료.결론 인동만성이선염적병인이특발성급결구이상위주;림상주요근거증상급영상학개변진행진단;대우내과치료효과불가자가행외과수술혹내경하치료.
Objective To investigate the etiology and clinical characteristics of chronic pancreatitis (CP) in children,so as to improve its diagnosis and treatment.Methods The etiology,clinical characteristics,radiological records and therapy were retrospectively analyzed in children with CP who were admitted to Beijing Children's Hospital Affiliated to Capital Medical University from July 2006 to May 2014.Results A total of 29 medical records of children with CP,including 19 male and 10 female,with a mean age of (8.5 ± 3.7) years,and the youngest case was a 2-year-old child,the oldest case was a 15-year-and-2-month-old child.The main etiological factor was idiopathic pancreatitis (51.7％,15/29 cases),and 9 cases were caused by anatomical anomalies (31.0％,9/29 cases).The main symptoms included abdominal pain (89.7％,26/29 cases),malnutrition (48.3％,14/29 cases),nausea and vomiting (31.0％,9/29 cases),and chest distress and dyspnea (17.2％,5/29 cases).The serum amylase level in 18 cases (62.1％) increased.The positive diagnostic rate of transabdominal ultrasound was 96.6％ (28/29 cases),and dilations of pancreatic ducts or/and intraductal stones were 82.8％ (24/29 cases).The positive rate by magnetic resonance cholangio-pancreatography (MRCP) for morphological changes in pancreas was 88.5％ (23/26 cases),and dilations of the pancreatic ducts were 80.8％ (21/26 cases).A total of 10 endoscopic retrograde cholangio-pancreatography (ERCP) procedures were performed on 6 children,and pancreatic ductal stenosis or dilations were detected in them.All the patients were treated conservatively at first,and then 7 cases of them had surgical therapy (oledochojejunostomy,choledochoduodenostomy,choledochocystectomy,etc.),aud 6 cases had stent insertion by ERCP.Conclusions The main causes of CP in children are idiopathic and anatomical anomaly,and its diagnosis is based on symptoms and imaging changes;surgical or endoscopic therapy can be used if internal therapy is not effective.