经内镜逆行胰胆管造影术在儿童胰胆管疾病中的应用  

Clinic application of endoscopic retrograde cholangiopancreatography in diagnosis and treatment of pancreaticobiliary diseases in children

作　　者：帅向华[1] 虞燕萍[1] 徐雯[1] 陈丽琼[1] 

机构地区：[1]浙江省杭州市第一人民医院儿科,310006

出　　处：《中华全科医学》2014年第2期194-196,共3页Chinese Journal of General Practice

摘　　要：目的探讨经内镜逆行胰胆管造影术（ERCP）在诊断和治疗儿童胰胆管疾病中的有效性和安全性。方法回顾分析2004年6月-2010年6月之间在杭州市第一人民医院进行ERCP术的32例患儿临床资料，其中男11例，女21例；≤12岁24例，〉12岁8例，平均年龄11．8岁；术前诊断为胆总管阻塞性疾病20例，慢性胰腺炎12例；≤12岁患儿需要在全身麻醉下行ERCP术。结果32例患儿共进行r34次ERCP，其中31例进行1次ERCP，1例乳头狭窄患儿进行了3次内镜下支架植入术。十二指肠乳头插管成功率为96．9％（31／32）。并发症的发生率为9．4％（3／32），其中1例为急性胰腺炎，2例为高淀粉酶血症，经保守治疗后均好转。没有发生重症胰腺炎、穿孔、出血或感染等严重并发症。对29例（90．6％）患儿进行_r随访，随访时间2～6年不等，平均3．6年，无不良后果发生。结论ERCP作为儿童胰胆管疾病的诊断和治疗工具，其并发症的发生率与成人相似。在麻醉方式上，年龄越小的儿童更需要全身麻醉。在训练有素的内镜医师操作下，ERCP在诊治儿童胰胆管疾病中的应用是有效和安全的。Objective To explore the utilization and safety of endoscopic retrograde cholangiopancreatography（ERCP） in the diagnosis and treatment of pancreaticobilia disease in children. Methods The clinical data of 32 children with pan- creaticobiliary diseases undergone ERCP between June 2004 and June 2010 in our hospital were reviewed retrospectively. There were 11 boys and 21 girls,the mean age was 11.8 years（24 cases were less than 12 years,and 8 cases were more than 12 years）. Indications for ERCP were 20 cases of common bile duct obstructions and 12 cases of chronic pancreati- tis. For the children who were less than 12 years old,ERCP was performed under general anaesthesia. Results 34 ERCP were performed on 32 patients. 31 patients had only one procedure performed, and 1 child with papillary stenosis had 3 in- terventions linked to stent treatment. The ampulla was cannulated, and the procedure was successfully completed in 96.9% （31/32）. The total complication rate was 9.4% , 1 acute pancreatitis and 2 hyperamylasemia were improved with conservative treatment. No severe pancreatitis, perforation, bleeding or infection was noted. 29 （90.6%） patients had fol- low-up of 2 to 6 years with a median length of 3.6 years,there were no negative consequences. Conclusion Endoscopic retrograde cholangiopancreatography is used as a diagnostic and therapeutic procedure in children with a complication rate similar to that seen in adults. The need for general anesthesia is much more frequent with children. When performed by well-trained endoscopists,ERCP is useful and safe in children.

关 键 词：胰胆管造影术 内窥镜逆行 胰腺疾病 胆管疾病 儿童 

分 类 号：R575[医药卫生—消化系统] R725.7[医药卫生—内科学]