内镜超声在小儿胰胆疾病中的诊断和治疗作用
Diagnostic and Therapeutic Roles of Endoscopic Ultrasound in Pediatric Pancreaticobiliary Disorders.
作者信息
Scheers Isabelle, Ergun Meltem, Aouattah Tarik, Piessevaux Hubert, Borbath Ivan, Stephenne Xavier, De Magnée Catherine, Reding Raymond, Sokal Etienne, Veyckemans Francis, Weynand Birgit, Deprez Pierre H
机构信息
*Department of Pediatric Gastroenterology, Hepatology and Nutrition †Department of Hepatogastroenterology ‡Pediatric Surgery and Transplantation Unit §Department of Pediatric Anesthesiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels ||Department of Pathology, Centre Hospitalier Universitaire Dinant-Godinne, Yvoir, Belgium.
出版信息
J Pediatr Gastroenterol Nutr. 2015 Aug;61(2):238-47. doi: 10.1097/MPG.0000000000000692.
OBJECTIVES
The diagnostic role of endoscopic ultrasound (EUS) in children has only recently been demonstrated, and that also to a lesser extent than in adults. Data on the technique's therapeutic indications remain scarce. We therefore sought to evaluate diagnostic and interventional EUS indications, safety, and impact in children with pancreaticobiliary disorders.
METHODS
We retrospectively reviewed our single pediatric center records, covering a 14-year period.
RESULTS
From January 2000 to January 2014, 52 EUS procedures were performed in 48 children (mean age: 12 years; range: 2-17 years) with pancreaticobiliary disorders for the following indications: suspected biliary obstruction (n = 20/52), acute/chronic pancreatitis (n = 20), pancreatic mass (n = 3), pancreatic trauma (n = 7), and ampullary adenoma (n = 2). EUS was found to have a positive impact in 51 of 52 procedures, enabling us to avoid endoscopic retrograde cholangiopancreatography (ERCP) (n = 13 biliary; n = 6 pancreatic), focusing instead on endotherapy (n = 7 biliary; n = 14 pancreatic) or reorienting therapy toward surgery (n = 7). EUS-guided fine-needle aspiration was carried out on 12 patients for pancreatic tumor (n = 4), pancreatic cyst fluid analysis (n = 4), autoimmune pancreatitis (n = 2), and suspicion of biliary tumor (n = 2). A total of 13 therapeutic EUS procedures (11 children) were conducted, including 9 combined EUS-ERCP procedures (7 children, mean age: 8 years, range: 4-11 years), 3 EUS-guided pseudocyst drainage (2 children), and 1 EUS-guided transgastric biliary drainage.
CONCLUSIONS
Our study reports on a large pediatric EUS series for diagnostic and therapeutic pancreaticobiliary disorders, demonstrating the impact of diagnostic EUS and affording insights into novel EUS and combined EUS-ERCP therapeutic applications. We suggest considering EUS as a diagnostic and therapeutic tool in the management of pediatric pancreaticobiliary diseases.
目的
内镜超声（EUS）在儿童中的诊断作用直到最近才得到证实，而且其应用程度也低于成人。关于该技术治疗适应证的数据仍然很少。因此，我们试图评估EUS在儿童胰腺胆管疾病中的诊断和介入适应证、安全性及影响。
方法
我们回顾性分析了我们单一儿科中心14年期间的记录。
结果
从2000年1月至2014年1月，对48例（平均年龄：12岁；范围：2 - 17岁）患有胰腺胆管疾病的儿童进行了52次EUS检查，适应证如下：疑似胆道梗阻（n = 20/52）、急性/慢性胰腺炎（n = 20）、胰腺肿块（n = 3）、胰腺外伤（n = 7）和壶腹腺瘤（n = 2）。在52次检查中有51次发现EUS有积极作用，使我们能够避免内镜逆行胰胆管造影（ERCP）（胆道13例；胰腺6例），转而侧重于内镜治疗（胆道7例；胰腺14例）或重新调整治疗方案为手术治疗（7例）。对12例患者进行了EUS引导下细针穿刺，用于胰腺肿瘤（n = 4）、胰腺囊肿液分析（n = 4）、自身免疫性胰腺炎（n = 2）以及疑似胆道肿瘤（n = 2）。共进行了13次EUS治疗操作（11例儿童），包括9次EUS - ERCP联合操作（7例儿童，平均年龄：8岁，范围：4 - 11岁）、3次EUS引导下假性囊肿引流（2例儿童）和1次EUS引导下经胃胆道引流。
结论
我们的研究报告了一大组用于诊断和治疗儿童胰腺胆管疾病的EUS病例系列，展示了诊断性EUS的影响，并为新型EUS及EUS - ERCP联合治疗应用提供了见解。我们建议将EUS视为儿童胰腺胆管疾病管理中的一种诊断和治疗工具。
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