经内镜逆行胰胆管造影术在儿童胰腺疾病治疗中的应用。

ERCP in the management of pancreatic diseases in children.

机构信息

Asian Institute of Gastroenterology, Hyderabad, India.

出版信息

Gastrointest Endosc. 2014 Feb;79(2):271-8. doi: 10.1016/j.gie.2013.07.060. Epub 2013 Sep 21.

DOI:10.1016/j.gie.2013.07.060

PMID:24060520

Abstract

BACKGROUND

ERCP experience in pancreatic disorders in children is limited.

OBJECTIVE

This study evaluated the utility and efficacy of ERCP in children with pancreatic diseases at a tertiary care referral center.

PATIENTS AND SETTINGS

Consecutive patients 18 years of age and younger who underwent ERCP for pancreatic diseases from January 2010 to June 2011 were identified. Indications, findings, interventions, adverse events, and outcomes were recorded.

RESULTS

A total of 221 ERCPs were performed in 172 children (102 boys, mean ± standard deviation age 13.8 ± 3.2 years, 157 therapeutic). A total of 143 children (83.1%) had chronic pancreatitis (CP), 19 (11%) had recurrent acute pancreatitis (RAP), and 10 (5.8%) had acute pancreatitis (AP). Indications included pain (153, 89.4%), pancreatic fistula (11, 6.3%), symptomatic pseudocyst (4, 2.3%), and jaundice (3, 1.7%). In chronic pancreatitis patients, findings included a dilated and irregular main pancreatic duct (92, 64.3%), pancreatic duct (PD) calculi (76, 53%), dominant PD stricture (23, 16%), PD leak (7, 4.9%), pancreas divisum (35, 24.5%), and common bile duct (CBD) stricture (3, 2%). Therapeutic procedures included major papilla sphincterotomy (93, 65%), minor papilla sphincterotomy (32, 22.3%), PD stenting (77, 53.8%), and CBD stenting (3, 2.2%). PD stones larger than 5 mm were retrieved endoscopically after 57 extracorporeal shock wave lithotripsy sessions in 50 patients (34.9%). In patients with RAP, 6 (31.5%) had complete and 1 partial pancreas divisum. All underwent minor papillotomy. In patients with AP, 4 (40%) had stenting for PD leak, 2 (20%) underwent CBD clearance for biliary pancreatitis, and 4 (40%) had transpapillary pseudocyst drainage. During 13 ± 4.7 months (range 6-22 months) of follow-up, improvement of symptoms was seen in 143 of 172 (83%) patients. Procedure-related adverse events were seen in 8 (4.7%) patients.

LIMITATIONS

Retrospective study.

CONCLUSION

ERCP is a safe therapeutic option for pancreatic disorders in children.

摘要

背景

儿童胰腺疾病的 ERCP 经验有限。

目的

本研究评估了三级转诊中心儿童胰腺疾病 ERCP 的实用性和疗效。

患者和设置

从 2010 年 1 月至 2011 年 6 月，连续对因胰腺疾病接受 ERCP 的 18 岁以下患者进行了识别。记录了适应证、发现、干预、不良事件和结局。

结果

在 172 名儿童中进行了 221 次 ERCP（102 名男孩，平均年龄为 13.8 ± 3.2 岁，157 次治疗性）。共有 143 名儿童（83.1%）患有慢性胰腺炎（CP），19 名（11%）患有复发性急性胰腺炎（RAP），10 名（5.8%）患有急性胰腺炎（AP）。适应证包括疼痛（153 例，89.4%）、胰瘘（11 例，6.3%）、有症状的假性囊肿（4 例，2.3%）和黄疸（3 例，1.7%）。在慢性胰腺炎患者中，发现包括扩张和不规则的主胰管（92 例，64.3%）、胰管结石（76 例，53%）、主导胰管狭窄（23 例，16%）、胰管漏（7 例，4.9%）、胰腺分裂（35 例，24.5%）和胆总管狭窄（3 例，2.2%）。治疗性操作包括主乳头括约肌切开术（93 例，65%）、副乳头括约肌切开术（32 例，22.3%）、胰管支架置入术（77 例，53.8%）和胆总管支架置入术（3 例，2.2%）。在 50 名患者（34.9%）中，经 57 次体外冲击波碎石术（ESWL）后，成功取出了 57 次直径大于 5mm 的胰管结石。在 RAP 患者中，6 例（31.5%）完全、1 例部分胰腺分裂。所有患者均接受了副乳头切开术。在急性胰腺炎患者中，4 例（40%）因胰管漏而行胰管支架置入术，2 例（20%）因胆源性胰腺炎而行胆总管清除术，4 例（40%）行经皮假性囊肿引流术。在 13 ± 4.7 个月（6-22 个月）的随访中，172 例患者中有 143 例（83%）症状改善。8 例（4.7%）患者出现与操作相关的不良事件。