D'Cruz A J, Kamath P S, Ramachandra C, Jalihal A
Department of Pediatric Surgery, St John's Medical College Hospital, Bangalore, India.
Acta Paediatr Jpn. 1995 Oct;37(5):630-3. doi: 10.1111/j.1442-200x.1995.tb03391.x.
We report on three children with pancreatic ascites confirmed by endoscopic retrograde cholangiopancreaticography (ERCP) and treated with surgery. The children presented with ascites, malnutrition and severe weight loss. Pancreatic ascites was diagnosed by elevated ascitic fluid and serum amylase levels. ERCP demonstrated a pseudocyst and the site of disruption of the pancreatic duct, but not the etiology of the pancreatitis. Following a period of nutritional support, surgery was carried out. Two of the children underwent a stented transgastric drainage of the pseudocyst; a recurrent pseudocyst in one of the children required a revision cystojejunostomy. The third child was treated with a Roux-en-Y cystojejunostomy. All the children are pain-free and without ascites and are doing well on long-term follow-up. We conclude that pancreatic ascites must be considered in the differential diagnosis of intractable ascites in children. An ERCP is essential in planning management and cystoenterostomy is the definitive treatment.
我们报告了3例经内镜逆行胰胆管造影（ERCP）确诊并接受手术治疗的胰源性腹水患儿。这些患儿均表现为腹水、营养不良和严重体重减轻。通过腹水和血清淀粉酶水平升高诊断为胰源性腹水。ERCP显示有假性囊肿及胰管破裂部位，但未明确胰腺炎的病因。经过一段时间的营养支持后进行了手术。其中2例患儿接受了假性囊肿的经胃支架引流术；1例患儿复发性假性囊肿需要行囊肿空肠吻合术修订。第3例患儿接受了Roux-en-Y囊肿空肠吻合术。所有患儿均无疼痛且无腹水，长期随访情况良好。我们得出结论，在儿童顽固性腹水的鉴别诊断中必须考虑胰源性腹水。ERCP对于制定治疗方案至关重要，囊肿肠吻合术是 definitive 治疗方法。（注：此处“definitive”在医学语境中可能指“决定性的、最终的、根治性的”等意思，结合前文推测此处可能是“根治性的”，但仅根据提供文本无法完全确定其准确含义）
