小儿慢性胰腺炎12例

目的总结小儿慢性胰腺炎的临床经验,探讨其诊断与手术治疗方法。方法回顾性分析12例慢性胰腺炎患儿的临床资料,其中男性9例,女性3例。平均年龄11.4岁,病程17.1个月。均因反复发作上腹痛入院。B超、CT或MRCP显示存在胰腺钙化2例,胰管扩张4例,胰管结石4例,胰腺假性囊肿5例。6例1期患儿予保守治疗;6例2期患儿予手术治疗,其中胰管切开取石、胰管空肠侧侧吻合术3例,胰体尾、脾切除术2例,腹腔引流术1例。结果 6例保守治疗患儿症状完全缓解后出院。6例手术治疗患儿中,除1例胰头部结石嵌顿未能取尽外,其余均恢复良好。12例患儿均获得6个月至5年随访,平均随访时间2.4年,其中3例复发腹痛,其余无临床症状。结论小儿慢性胰腺炎多依靠影像学检查确诊。合并胰管结石者首选胰管切开取石、大口径胰管空肠吻合术,可有效缓解疼痛,创伤小,并发症少。

Clinical diagnosis and treatment of chronic pancreatitis in children

Objetive Objetive To explore the diagnosis and surgical treatment of chronic pancreatitis in children.Methods There were 9 boys and 3 girls with an average age of 11.4 years and a disease duration of 17.1 months.All patients presented with recurrent upper abdominal pain.B-ultrasound,computed tomo-graphy (CT)or magnetic resonance cholangiopancreatography (MRCP)showed pancreatic calcification (n =2),pancreatic duct dilatation (n =4),pancreatolithiasis (n =4)and pancreatic pseudocyst (n =5).Six stage — 1 cases received conservative treatment.And another 6 stage —2 cases were operated,including pancre-atolithotomy plus pancreaticojejunostomy (modified Puestow procedure)(n =3),resection of pancreatic body&tail with splenectomy (n =2)and abdominal drainage (n =1).Results The symptoms were completely re-lieved before discharge for 6 conservatively treated cases.Among 6 operated cases,except for 1 case of calcu-lus incarcerated in pancreatic head,the remainder recovered well postoperatively.During an average follow-up period of 2.4 (0.5 -5)years,only 3 cases had recurrent abdominal pain.Conclusions The diagnosis of pe-diatric chronic pancreatitis is dependent on imaging examination.As a first choice for pancreatolithiasis,modi-fied Puestow procedure can effectively relieve pain,reduce trauma and cause fewer complications.