摘要
目的 探讨胰胆管损伤患儿经内镜逆行胰胆管造影(ERCP)及支架置入的效果.方法 回顾性队列研究.分析2021年1月至2022年12月在首都医科大学附属北京儿童医院诊断为胰胆管损伤并行ERCP及支架置入的22例患儿临床资料,收集患儿的人口学信息、临床资料、内镜下治疗方式、术后并发症及临床预后情况,分析引起胰胆管损伤的病因、胰胆管损伤发生的部位、ERCP术后并发症情况及支架置入后好转及痊愈时间.根据引起胰胆管损伤的病因分为外科术后、胰腺外伤、急性胰腺炎、慢性胰腺炎、系统性红斑狼疮5组;根据胰胆管损伤发生的部位分为胆总管、胰头、胰体、胰尾4组,采用多因素方差分析比较各组间好转及痊愈时间.结果 22例患儿中男8例、女14例,年龄7.5(3.3,10.8)岁,引起胰胆管损伤的主要原因是手术(7例)及外伤(5例);22例患儿中19例为胰胆管瘘、3例为胰胆管狭窄.22例患儿完成33例次ERCP手术,3例次胆管或胰管狭窄者均未能越过狭窄处,无法进行内镜干预,手术成功率91％(30/33),首次ERCP成功者均置入胰管或胆管支架,支架位于胰胆管瘘口处.3例次出现术后胰腺炎(9％,3/33),5例次出现高淀粉酶血症(15％,5/33),4例次术后感染(12％,4/33).成功置入支架患儿随访均＞1年,术后体外引流均有明显好转.不同病因引起的胰胆管损伤患儿好转时间差异无统计学意义(F=0.65,P=0.637),愈合时间差异有统计学意义(F=6.46,P=0.004),其中系统性红斑狼疮引起的损伤的愈合时间与外科术后、外伤、急性胰腺炎、慢性胰腺炎组间比较差异均有统计学意义(均P＜0.05).不同胰胆管损伤部位患儿的好转及愈合时间差异均无统计学意义(均P＞0.05).结论 ERCP及支架置入可安全有效地改善胰胆管损伤患儿的临床症状,早期干预可改善远期预后.
Abstract
Objective To investigate the therapeutic effectiveness of endoscopic retrograde cholangiopancreatography(ERCP)and stent implantation in the treatment of pancreaticobiliary injuries in children.Methods A retrospective analysis was conducted on the clinical data of children diagnosed with pancreaticobiliary injury and undergoing ERCP and stent implantation at Beijing Children's Hospital,Capital Medical University from January 2021 to December 2022.Demographic information,clinical data,endoscopic treatment methods,postoperative complications and clinical prognosis of the children were collected.The etiology,location of pancreaticobiliary injury,occurrence of complications after endoscopic treatment,and the time for improvement and recovery after endoscopic treatment were analyzed.The patients were divided into 5 groups according to the etiologies of pancreaticobiliary duct injuries:post-surgical,pancreatic trauma,acute pancreatitis,chronic pancreatitis,and systemic lupus erythematosus groups.They were also classified into 4 groups according to the sites of pancreaticobiliary duct injuries:common bile duct,pancreatic head,pancreatic body,and pancreatic tail groups.Multi-factor analysis of variance was used for comparing the time of improvement and recovery among different groups.Results Among 22 patients,there were 8 males and 14 females,and the age was 7.5(3.3,10.8)years.There were 19 cases of pancreatic or bile duct fistula,and 3 cases of pancreatic or bile duct stenosis.A total of 33 endoscopic procedures were performed on the 22 patients,out of which,3 duct stenosis were failed to insert the stent because the catheter failed to pass through the stenosis site.The success rate was 91％(30/33).The pancreatic duct or bile duct stent was inserted,with the stent located at pancreatic or bile duct fistula.Postoperative complications included pancreatitis in 3 cases(9％,3/33),hyperamylasemia in 5 cases(15％,5/33),and postoperative infection in 4 cases(12％,4/33).All patients were followed up for more than 1 year.Significant improvement was observed in external drainage and imaging monitoring among patients with successfully placed stents.There was no significant difference in the improvement time of ERCP in the treatment of pancreaticobile duct injury caused by different etiology(F=0.65,P=0.637).However,there were significant differences in healing time(F=6.46,P=0.004),among which the healing time of injuries caused by systemic lupus erythematosus was significantly different from that after surgery,trauma,acute pancreatitis and chronic pancreatitis(all P＜0.05).There was no significant difference in the improvement and healing time among different injury sites(all P＞0.05).Conclusions ERCP and stent implantation can safely and effectively improve the clinical symptoms of children with pancreaticobiliary injury.Early intervention can improve long-term prognosis.
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