慢性胰腺炎3例临床及内镜诊治分析

doi:10.12372/jcp.2022.21e0866

摘要/Abstract

摘要：

目的探讨由基因或结构异常所致慢性胰腺炎患儿的临床特点,及其经内镜逆行胰胆管造影术（ERCP）诊治的临床疗效。方法回顾分析2020年7-10月采用ERCP治疗的3例慢性胰腺炎患儿的临床资料。结果 3例慢性胰腺炎患儿,2例男性、1例女性,年龄为11岁1例,12岁2例,主要临床症状均为慢性腹痛,无胰腺内外分泌功能不全的表现。2例患儿由基因变异所致,分别为SPINK1、LPL基因变异;1例由结构异常所致,为胰管先天发育异常,胰体部胰管呈分支状。3例患儿常规治疗无效,实施ERCP治疗,通过取出结石、清理胰管、放置支架,以改善引流,缓解胰管压力。术后2例患儿的胰酶均恢复正常,腹痛缓解;1例术后胰酶增高,3天后恢复正常。结论由基因或结构异常所致儿童慢性胰腺炎行ERCP诊治安全有效。

关键词: 慢性胰腺炎, 基因变异, 胰腺解剖结构异常, 内镜下逆行胰胆管造影术, 儿童

Abstract:

Objective To evaluate the clinical characteristics of children with chronic pancreatitis caused by genetic and structural abnormalities and the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP). Methods The clinical data of 3 children with chronic pancreatitis treated with ERCP from July to October in 2020 were retrospectively analyzed. Results There were 3 children (2 boys and 1 girl) with chronic pancreatitis. One patient was 11 years old and the other two were 12 years old. The main clinical symptoms were chronic abdominal pain without manifestation of pancreatic secretion insufficiency. Two patients were caused by gene variation, which were SPINK1 and LPL gene variation respectively. One patient was caused by structural abnormality, and the pancreatic duct was bifurcated in the body of the pancreas, which was considered as congenital abnormal development of the pancreatic duct. Three children were treated with ERCP after conventional treatment failed. By removing the stones, cleaning the pancreatic duct, placing stents, improving drainage and relieving the pressure of the pancreatic duct, the trypsin levels in 2 patients were restored to normal and the abdominal pain was relieved. The trypsin levels were increased in 1 patient after operation and returned to normal 3 days later. Conclusions ERCP is safe and effective in diagnosis and treatment of childhood chronic pancreatitis caused by genetic or structural abnormalities.

Key words: chronic pancreatitis, genetic variation, abnormal anatomical structure of pancreas, endoscopic retrograde cholangiopancreatography, child

邹标, 刘圣烜, 覃华, 黄志华, 舒赛男. 慢性胰腺炎3例临床及内镜诊治分析[J]. 临床儿科杂志, 2022, 40(2): 144-148.

ZOU Biao, LIU Shengxuan, QIN Hua, HUANG Zhihua, SHU Sainan. Clinical and endoscopic diagnosis and treatment of 3 cases of chronic pancreatitis[J]. Journal of Clinical Pediatrics, 2022, 40(2): 144-148.

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