经内镜逆行胰胆管造影术应用于儿童胆胰疾病的大样本研究

Endoscopic retrograde cholangiopancreatography for children with pancreaticobiliary diseases： a large-scale study

摘要:

目的 探讨经内镜逆行胰胆管造影术（ERCP）在儿童胆胰疾病诊治中的疗效与安全性。 方法 回顾性分析2006年7月至2016年6月期间于杭州市第一人民医院消化内科住院接受ERCP诊治的共115例年龄在18岁以下的患儿的临床资料，总结分析其麻醉方式、治疗方法、成功率、术后并发症情况。 结果 115例患儿共接受221例次ERCP操作，其中，诊断为胆总管结石81例次，胆总管囊肿22例次，胆道蛔虫症3例次，慢性胰腺炎66例次，胰腺分裂症45例次，急性胰腺炎43例次。31例次在气管插管全身麻醉下进行，分别完成胆、胰管开口切开，胆、胰管取石，胆、胰管内支架置入，鼻胆管、鼻胰管引流等相关操作。操作成功率为98.6％（218／221），操作相关并发症的发生率为7.2％（16／221），包括7例次（3.2％）术后胰腺炎，5例次（2.3％）术后出血，4例次（1.8％）术后胆管炎，并发症均于治疗后缓解。 结论 儿童胆胰疾病中先天性解剖异常较为常见，早期儿童胆胰疾病由经验丰富的内镜医生进行ERCP诊治是有效和安全的。

Abstract:

Objective To explore the efficacy and safety of endoscopic retrograde cholangiopancreatography （ERCP） for the diagnosis and treatment of children with pancreaticobiliary diseases. Methods Clinical data of 115 children with pancreaticobiliary diseases who underwent ERCP between July 2006 and June 2016 at Hangzhou First People′s Hospital were reviewed.Anesthesia types， therapeutic methods，success rate and postoperative complications were summarized. Results A total of 221 ERCP procedures were performed on 115 patients. Eighty one cases were diagnosed as common bile duct stones， 22 bile duct cysts， 3 biliary ascariasis， 66 chronic pancreatitis， 45 pancreas divisum， and 43 acute pancreatitis. Thirty-one procedures were performed under general anesthesia. Dissection of pancreatic duct and biliary duct， calculus removal， insertion of pancreatic duct and biliary duct， and draining in pancreatic duct or biliary duct were performed. The success rate of the ERCP procedure was 98.6％ （218／221） with complication rate of 7.2％（16／221）. In terms of postoperative complications， post-ERCP pancreatitis occurred in 7 （3.2％） cases， bleeding in 5 （2.3％），and postoperative cholangitis in 4（1.8％）.All the complications were cured after treatment. Conclusion Congenital anatomic anomalies are common in children with pancreaticobiliary diseases. Early diagnosis and treatment of ERCP by an experienced endoscopist for children with pancreaticobiliary diseases is effective and safe.