Fukushima Hiroko, Fukushima Takashi, Suzuki Ryoko, Enokizono Takashi, Matsunaga Maki, Nakao Tomohei, Koike Kazutoshi, Mori Kensaku, Matsueda Kiyoshi, Sumazaki Ryo
Department of Pediatrics, University of Tsukuba Hospital, University of Tsukuba, Tsukuba, Japan.
Pediatr Int. 2013 Apr;55(2):e11-3. doi: 10.1111/j.1442-200X.2012.03702.x.
Severe acute pancreatitis is one of the critical conditions that may develop in children with cancer. The leading cause of death due to acute pancreatitis is infectious pancreatitis or circulation collapse. Therefore, patients who develop acute pancreatitis while undergoing chemotherapy or after hematopoietic transplantation are at risk for a life-threatening and fatal course. We treated 140 patients with malignancy from April 2002 to March 2009 at our hospital and encountered 3 patients under neutropenia who developed severe acute pancreatitis. Two of them were successfully treated with continuous regional arterial infusion of a protease inhibitor and antibiotic even under agranulocytosis. Another patient was treated with conventional therapy with intravenous antibiotics plus a protease inhibitor and total or partial parenteral nutrition. Even though the two patients treated with continuous regional arterial infusion presented much more severe conditions, their symptoms resolved earlier. In conclusion, acute pancreatitis is one of the severe complications of childhood malignancy. Even under agranulocytosis, continuous regional arterial infusion of a protease inhibitor and antibiotic was well tolerated and effective among our cases and might reduce early death due to pancreatitis.
重症急性胰腺炎是癌症患儿可能出现的危急病症之一。急性胰腺炎导致死亡的主要原因是感染性胰腺炎或循环衰竭。因此，在化疗期间或造血干细胞移植后发生急性胰腺炎的患者，面临着危及生命和致命病程的风险。2002年4月至2009年3月，我们在本院治疗了140例恶性肿瘤患者，其中有3例中性粒细胞减少的患者发生了重症急性胰腺炎。其中2例即使在粒细胞缺乏的情况下，通过持续区域动脉输注蛋白酶抑制剂和抗生素也成功治愈。另一例患者接受了静脉抗生素加蛋白酶抑制剂以及全肠外或部分肠外营养的传统治疗。尽管接受持续区域动脉输注治疗的2例患者病情要严重得多，但他们的症状缓解得更早。总之，急性胰腺炎是儿童恶性肿瘤的严重并发症之一。在我们的病例中，即使在粒细胞缺乏的情况下，持续区域动脉输注蛋白酶抑制剂和抗生素也耐受性良好且有效，可能会减少胰腺炎导致的早期死亡。
