青少年慢性胰腺炎的内镜诊断与治疗

目的：研究诊断性和治疗性经内镜逆行胰胆管造影术(ERCP)在青少年慢性胰腺炎(CP)诊断及治疗中的价值。方法：回顾分析1997年2月～2002年2月间确诊为青少年CP并行ERCP的13例临床资料。结果：13例中12例存在腹痛症状，10例有“胰腺炎”病史。ERCP见胰管扩张12例，胰管结石7例，胰腺假性囊肿2例，胰腺分裂症3例，胆囊结石l例。内镜下治疗：乳头括约肌切开术7例，胰管取石6例，支架置入5例，胰管狭窄扩张术4例，副乳头切开2例。ERCP后高淀粉酶血症4例，胰腺炎急性发作3例，均为水肿型胰腺炎。经6—68个月随访，ll例未复发，2例复发者经再次ER-CP治疗后腹痛未再出现。结论：ERCP对青少年CP的诊断及治疗有较高的价值。但青少年CP患者ERCP术后具有较高的并发症发生率，对此内镜医师应高度重视。

Chronic pancreatitis in teenaged patients treated by endoscopic intervention

Objective To explore the diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatography ( ERCP) in teenagers with chronic pancreatitis. Methods Thirteen teenagers with chronic pancreatitis diagnosed and treated by consecutive ERCP procedures in our hospital from Feb 1997 to Feb 2002 were studied retrospectively. Results Of the 13 patients 12 had abdominal pain and 10 had history of acute/chronic pancreatitis. The ERCP findings were as follows: pancreatic duct stricture and/ or dilation 12, pancreatic duct stones 7, pancreatic pseudocysts 2, pancreas divisum 3, and cholecystolithia-sis 1. Therapeutic interventions included EST 7 , basket stone extraction 6, placement of pancreatic duct stent 5 , pancreatic duct stricture bougie or balloon dilation 4, accessory papillotomy 2 and endoscopic papillary dilation 1. In the 6 - 68 months follow - up, 11 (84. 6% ) never had recurrence of pancreatitis or abdominal pain ,2 patients had no abdominal pain after the second ERCP procedure. There were procedure -related complications of hyperamylasemia in 4 cases(30. 8% ) and pancreatitis in 3 cases(23. 1% ). Conclusion ERCP has significant value in diagnosing and treating chronic pancreatitis in teenagers, but has a rather high rate of complication . It suggested that the restrict selection of indication and safe application of the procedures in pediatric patients may be expected to decrease the adverse events of ERCP.