Davenport M, Stringer M D, Howard E R
Department of Paediatric, Hepatobiliary Surgery, King's College Hospital, London, England.
J Pediatr Surg. 1995 Mar;30(3):474-7. doi: 10.1016/0022-3468(95)90059-4.
The relationship between levels of biliary amylase measured at operation and clinical features was studied in a series of 55 children with congenital biliary dilatation (choledochal cyst) who presented between 1976 and 1993. There were 36 cystic and 19 fusiforms dilatations in the series. The most common modes of presentation were painless jaundice (n = 23) and pancreatitis (n = 22). Five infants presented with abnormal antenatal ultrasound examinations. Children with pancreatitis were older than those with painless jaundice (4.2 versus 1.5 years; P = .005), and a higher proportion had raised levels of biliary amylase (100% versus 44%; P < .0001). There was no difference in the age at presentation (P = .32), clinical mode of presentation (P = .3), or the level of biliary amylase (P = .25) between cystic and fusiform dilatations. A correlation was found between age at surgery and biliary amylase in the cystic (rs = 0.55; P = .001) but not in the fusiform group (P = .22). All infants with antenatal diagnoses were cystic dilatations. Choledochal cystic dilatations that were diagnosed antenatally did not have significant amylase reflux, suggesting that the aetiology of this subgroup is truly congenital. Children who present at a later age with pancreatitis invariably have high levels of biliary amylase, which is presumed to occur because of a common channel and reflux of biliary and pancreatic secretions.
对1976年至1993年间收治的55例先天性胆管扩张症（胆总管囊肿）患儿，研究了手术时测定的胆汁淀粉酶水平与临床特征之间的关系。该系列中，有36例为囊性扩张，19例为梭形扩张。最常见的表现方式为无痛性黄疸（n = 23）和胰腺炎（n = 22）。5例婴儿产前超声检查异常。胰腺炎患儿的年龄大于无痛性黄疸患儿（4.2岁对1.5岁；P = 0.005），且胆汁淀粉酶水平升高的比例更高（100%对44%；P < 0.0001）。囊性扩张和梭形扩张在发病年龄（P = 0.32）、临床表现方式（P = 0.3）或胆汁淀粉酶水平（P = 0.25）方面无差异。在囊性扩张组中，发现手术年龄与胆汁淀粉酶之间存在相关性（rs = 0.55；P = 0.001），而在梭形扩张组中未发现相关性（P = 0.22）。所有产前诊断的婴儿均为囊性扩张。产前诊断的胆总管囊肿性扩张没有明显的淀粉酶反流，提示该亚组的病因确实是先天性的。年龄较大时出现胰腺炎的患儿胆汁淀粉酶水平总是很高，推测这是由于胆管和胰管有共同通道以及胆汁和胰液反流所致。
