儿童胰腺炎病因分析及ERCP的诊治作用  

Etiology of pancreatitis in pediatric patients and effect of endoscopic retrograde cholangiopancreatography

作　　者：陈郅祺 李燕妮 谢晓曦 向波[2] 王春晖[1,3] CHEN Zhiqi;LI Yanni;XIE Xiaoxi;XIANG Bo;WANG Chunhui(Department of Gastroenterology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Pediatric surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;West China Center of Excellence for Pancreatitis,Institute of Integrated Traditional Chinese and Western Medicine,,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院消化内科,成都610041 [2]四川大学华西医院小儿外科,成都610041 [3]四川大学华西医院中西医结合中心,胰腺炎中心,成都610041

出　　处：《中国普外基础与临床杂志》2024年第2期193-198,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨儿童胰腺炎的病因以及内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)的诊治作用。方法回顾性收集2008年1月至2023年6月期间于四川大学华西医院诊治的241例胰腺炎患儿为研究对象,其中慢性胰腺炎34例,急性胰腺炎207例;初发168例,复发73例。结果初发组患儿的住院时间长于复发组[10.0(7.0,16.0)d vs.7.5(6.0,11.8)d,P=0.012],初发组中AP的占比(163/168,97.0%)大于复发组(44/73,60.3%),P<0.001;初发组和复发组患儿的急性胰腺炎病因构成比差异无统计学意义(χ^(2)=7.504,P=0.347),但初发组的第1位病因为胆源性因素(38/163,23.3%),第2位为胆胰解剖异常(22/163,13.5%);复发组中则以胆胰解剖异常为第1位病因(13/44,29.5%),胆源性因素为第2位病因(7/44,15.9%)。在207例急性胰腺炎患儿中,有明确病因的有114例(55.1%),其中胆源性因素45例(21.7%),胆胰解剖异常35例(16.9%),创伤性因素12例(5.8%),药源性因素10例(4.8%)。因胰腺炎行ERCP治疗的儿童患者共66例,共计行ERCP手术103例次,手术插管成功率达100%。因AP行ERCP的患儿中,以胆源性与胆胰解剖异常患儿为主(23/37,62.2%)。胆源性AP患儿中,ERCP单次手术取净结石率为80.0%(8/10)。术后所有患儿的腹痛、黄疸、发热等临床症状明显改善,无患儿发生胆管炎、出血、穿孔等并发症。结论胆源性、先天性胆胰解剖异常、药物以及创伤均是导致儿童发生急性胰腺炎的常见病因。ERCP对胆源性胰腺炎、胰腺解剖异常以及慢性胰腺炎的儿童患者是一种安全且有效的治疗方式。Objective To investigate the etiology of pediatric pancreatitis and the effect of endoscopic retrograde cholangiopancreatography(ERCP)in it.Methods Patients hospitalized for pancreatitis in West China Hospital of Sichuan University from Jan.2008 to Jun.2023 were included according to the inclusion and exclusion criteria.Totally,241 cases(207 cases with acute pancreatitis and 34 with chronic pancreatitis)were included.Patients were divided into primary group(n=168)and recurrent group(n=73)according to their previous medical history.Results The duration of hospitalization in the primary group was longer than that in the recurrent group[10.0(7.0,16.0)d vs.7.5(6.0,11.8)d,P=0.012].The proportion of acute pancreatitis in primary group(163/168,97.0%)was higher than that in the recurrent group(44/73,60.3%),P<0.001.There was no significant difference in the etiological component ratio between the primary and recurrent groups(χ^(2)=7.504,P=0.347).However,in the primary group,the first etiology was biliary factors(38/163,23.3%),and the second was biliary pancreatic anatomic abnormality(22/163,13.5%).In the recurrence group,biliary pancreatic anatomic abnormality(13/44,29.5%)was the first cause,and biliary factor(7/44,15.9%)was the second cause.Among 207 cases with acute pancreatitis,there were 114 cases(55.1%)with clear etiology,including 45 cases(21.7%)of biliary factors,35 cases(16.9%)of abnormal biliary pancreatic structure,12 cases(5.8%)of traumatic factors,and 10 cases(4.8%)of drug-induced factors.In this study,66 cases were treated with ERCP for pancreatitis,and a total of 103 ERCP operations were performed with cannulation success rate of 100%.Twenty-three cases(23/37,62.2%)of acute pancreatitis resulted from biliary and biliary pancreatic structure abnormalities received ERCP.In biliary acute pancreatitis,the removal rate of choledocholithiasis in single ERCP operation was 80.0%(8/10).The clinical symptoms(abdominal pain,jaundice,and fever)of all cases were significantly improved after surgery,and no complications

关 键 词：急性胰腺炎 慢性胰腺炎 儿童 病因 内镜下逆行胰胆管造影术 

分 类 号：R725.7[医药卫生—儿科]