小儿假性胰腺囊肿的诊断和治疗

目的探讨准确地诊断和治疗小儿假性胰腺囊肿.方法总结近10年来我们收治经B超、钡餐、CT和MRI以及手术证实的假性胰腺囊肿15例.结果发现15例中男11例,女4例,年龄最小1岁4个月,最大13岁,平均年龄9.4岁.而且7例有明显外伤史(7/15,占40%),恶心呕吐(14/15,占93%)、腹痛(11/15,占73%),腹部肿块(10/15,占66%)为主要临床表现,其次有发热、消瘦、贫血.此外,在诊断上除依靠病史、体检和临床表现外,B超是最适宜和有价值的诊断依据,钡餐、CT和MRI可以帮助诊断和鉴别诊断,还发现一旦血清淀粉酶下降后又重新回升,不但对确诊有重要意义,也是手术的重要指证.14例接受手术治疗患儿均恢复良好,无1例死亡.结论①小儿假性胰腺囊肿诊断除主要依靠病史、体征外,B超对小儿仍是有价值的辅助检查,诊断困难时可结合钡餐、CT和MRI加以鉴别.②小儿假性胰腺囊肿多与外伤有关,男＞女,因男孩好动、顽皮受伤机率多.③囊肿形成超过6周,或者B超显示囊肿壁形成明显时应选用内引流手术,较大囊肿仅外引流难以治愈.

Diagnosis and Management of Pancreatic Pseudocyst in Children

Objective: To investigate the diagnosis and management of pancreatic pseudocyst in children. Methods: 15 cases of pancreatic pseudocyst in children Who were diagnosed by ultrasound (US), barium meal (BM), computerized tomography (CT) and magnetic resonance image (MRI), were reviewed in the past ten years. Results: There were 11 boys and 4 girls of 15 cases ranging in age from 4 months to 13 years with mean age 9.4 years. Traumatic history (7/15), nausea and vomiting (14/15), abdominal pain (11/15) and abdominal mass (10/15) were main clinical presentations. The other appearances were fever, thin and anemia. The most appropriate and valuable diagnostic method was US besides history, signs and clinical presentations. BM, CT and MRI were valuable for diagnosis and differential diagnosis. Elevating amylase after return to normal range was the factor for confirming the diagnosis and was also the indication to operation. 14 cases that underwent operations recovered smoothly and no one died. Conclusions: (l) The diagnosis of pancreatic pseudocyst should depend on history and signs. The most valuable aid might be US, BM, CT and MRI could be important in differential diagnosis. (2) Most of pancreatic pseudocyst in children were associated with trauma. There were many boys because of their active and so as to have more incidences to be injured. (3) Indications for internal drainage were that pseudocyst had formed for more than 6 weeks or the cyst wall had formed apparently. It was difficult to cure large cyst with only external drainage.