内镜逆行胰胆管造影在儿童胆胰疾病中的应用
Clinical application and analysis of endoscopic retrograde cholangiopancreatography in children with biliary and pancreatic diseases
潘祝彬 1戚士芹 1张涛 1周玉良 1刘振生 1张振强 1杨涌1
作者信息
- 1. 安徽省儿童医院普外科,合肥 230000
- 折叠
摘要
目的 探究内镜逆行胰胆管造影(ERCP)在儿童胆胰疾病中的临床应用价值.方法 回顾性分析2022年6月至2023年9月安徽省儿童医院普外科收治的21例胆胰疾病患儿的临床资料,其中男性8例,女性13例,年龄9(5,11)岁,年龄范围3～14岁.收集所有患儿的ERCP操作情况、操作成功率及临床表现,分析比较21例患儿首次ERCP术前与术后3 d的血液指标变化情况,记录术后并发症发生情况.结果 21例患儿的临床表现为腹痛(16例次)、黄疸(3例次)、腹胀(1例次)、发热(1例次)、恶心呕吐(10例次).21例患儿在全麻下共接受ERCP 24例次,成功23例次,失败1例次,成功率为95.8％(23/24).治疗措施包括副乳头切开3例次,球囊扩张9例次,鼻胆管引流9例次,胆管支架置入4例次,胆管取石10例次,胰管支架置入5例次,胰管取石3例次,胆管内支架取出术2例次.与ERCP前相比,21例患儿术后总胆红素[(44.61±14.44)µmmol/L比(81.63± 24.14)µmmol/L]、直接胆红素[20.32(16.34,24.27)μmmol/L 比 36.81(33.01,42.22)µmmol/L]、天冬氨酸氨基转移酶[128.4(125.4,132.8)U/L比250.8(248.7,261.2)U/L]、丙氨酸氨基转移酶[180.1(176.4,190.2)U/L 比 303.5(301.0,320.9)U/L]、γ-谷氨酰转移酶[(135.8±42.3)U/L 比(206.4±78.1)U/L]均降低,差异有统计学意义(均P＜0.001).21例患儿在ERCP诊疗后共发生并发症2例,发生率为9.52％,2例均为轻度术后胰腺炎.结论 ERCP在儿童胆胰系统疾病的诊疗中安全有效.
Abstract
Objective To investigate the application value of endoscopic retrograde cholangiopan-creatography(ERCP)in the clinical diagnosis and treatment of biliary and pancreatic diseases in children.Methods The clinical data of 21 children with biliary and pancreatic diseases admitted to the Department of General Surgery of Anhui Children's Hospital from June 2022 to September 2023 were retrospectively ana-lyzed,including 8 males and 13 females,aged 9(5,11)years old,ranging from 3 to 14 years old.The ERCP operation status,operation success rate and clinical manifestations of all children were summarized,and the changes of blood indexes before and 3 days after the first ERCP were analyzed and compared in 21 children,and the occurrence of postoperative complications were recorded.Results The clinical manifesta-tions of the 21 cases were abdominal pain(16 cases),jaundice(3 cases),abdominal distension(1 case),fever(1 case),nausea and vomiting(10 cases).Twenty-one children received ERCP under general anes-thesia for 24 times,23 cases of which were successful and the remaining was failed,with a success rate of 95.8％(23/24).The treatment measures included 3 cases of duodenal papillotomy,9 cases of endoscopic papillary balloon dilatation,9 cases of nasobiliary drainage,4 cases of endoscopic retrograde biliary drain-age,10 cases of bile duct stone extraction,5 cases of pancreatic duct stent placement,3 cases of pancreatic duct stone extraction,and 2 cases of intrabile duct stent extraction.Compared with preoperative ERCP,the total bilirubin[(44.61±14.44)µmmol/L vs.(81.63±24.14)µmmol/L]and direct bilirubin[20.32(16.34,24.27)μmmol/L vs.36.81(33.01,42.22)µmmol/L],aspartate aminotransferase[128.4(125.4,132.8)U/L vs.250.8(248.7,261.2)U/L],alanine aminotransferase[180.1(176.4,190.2)U/L vs.303.5(301.0,320.9)U/L],y-glutamyltransferase[(135.8±42.3)U/L vs.(206.4 ±78.1)U/L]were decreased,the difference was statistically significant(all P＜0.001).Complications occurred in 2 of the 21 patients after ERCP diagnosis and treatment,the incidence rate was 9.52％,and both cases were mild postoperative pancreatitis.Conclusion ERCP is safe and effective in the diagnosis and treatment of biliary and pancreatic diseases in children.
关键词
胰胆管造影术,内窥镜逆行/胆胰疾病/儿童/治疗/诊断Key words
Cholangiopancreatography,endoscopic retrograde/Biliary and pancreatic diseases/Child/Treatment/Diagnosis引用本文复制引用
出版年
2024
NETL
NSTL
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