儿童急慢性胰腺炎的诊治

摘要：儿童胰腺炎发病率逐年上升,不论急性或慢性,其主要症状都是腹痛,易漏诊、误诊。早期诊断依赖于医生的警觉以及合适的实验室及影像学检查。治疗上以内科治疗为主,但需多学科参与,以更好地改善疾病的预后。     

小儿急性胰腺炎的实验室诊断研究进展

小儿急性胰腺炎诊断及预测其严重程度的传统实验室指标包括血、尿淀粉酶,血脂肪酶,尿胰蛋白酶原-2,C反应蛋白,淀粉酶和肌酐清除比率以及细胞因子等.传统实验室诊断指标操作简便、经济,但敏感性和特异性不够理想.近年来降钙素原、磷脂酶A2、胰酶试剂盒、胰蛋白酶原活性肽、羧肽酶B活性肽、人胰腺特异蛋白/羧肽酶原B、多形核白细胞弹性蛋白酶、血清淀粉样蛋白A及细胞间黏附分子1等新的实验室指标被相继发现和应用,为小儿急性胰腺炎的早期诊断和病情严重程度预测提供了可靠的判断方法,但新的实验室诊断指标多数检测繁琐、价格昂贵,限制了其在临床的广泛应用.因此,仍需寻找更敏感、特异、廉价和可操作性强的实验室指标应用于临床诊断.     

小儿急性胰腺炎

急性胰腺炎(AP)是小儿急腹症之一,近年来发病率呈上升趋势,现主要介绍近期国内外关于小儿AP的发病原因、病理演变及诊断和治疗现状。小儿AP目前认为主要由胆源性或外伤引起,90%为水肿型,出血坏死型少见,大多数常可经非手术治愈,少数如出现高热、腹肌紧张不能排除外科其他急腹症时需剖腹探查、腹腔引流,如并巨大假性囊肿则需行囊肿切除或囊肿消化道内引流术。     

小儿急性胰腺炎的临床特点与实验研究

目前认为急性胰腺炎不单是胰腺本身消化而且是白细胞系统过度激活产生多种炎性介质导致多脏器损害的疾病。1 984年后国际规定急性胰腺炎只有 2种诊断 :轻型急性胰腺炎和重症急性胰腺炎。 1 996年全国外科学会贵阳会议规定按ＡＰＡＣＨＥ Ⅱ评分法制定 ,总分≥ 8分为重症[1 ] 。本文报道 64例 ,按以上分类与评分均≥ 8分 ,现结合实验研究报道如下。资料与方法一、临床资料1 .一般资料　 1 993～ 2 0 0 1年收治64例中 ,男 44例 ,女 2 0例。年龄 3～ 1 3岁 ,平均 1 0 .5岁。2 .病因　胆源性 60例 (93 .7% ) ,其中 50例经手术证实 :胆道蛔虫 2 8…     

小儿急性胰腺炎的病因诊断与治疗

小儿急性胰腺炎有较高的发病率和病死率。自1959年Frey 和Redo 在世界文献上报告36例小儿急性胰腺炎后,国内外屡有报告,并对该病进行多方面研究,有了一些新的认识。一、病因小儿急性胰腺炎的病因仍不明确,目前提出较多的病因有以下各种:(1)创伤性外伤后可立即发生或间歇期发生,有时合并假性胰腺囊肿。(2)继发于其它全身性疾病如流行性腮腺炎、猩红热、肠伤寒、大面积烧伤;也可继发于     

小儿急性胰腺炎临床分析与病因探讨

小儿急性胰腺炎(acute pancreatitis,AP)一直被认为是比较少见的,但随着我们对该病认识的加深,小儿AP的发病率有所升高。小儿AP的病因随着检查手段的增多也比以前明确。我院儿外科从2001年12月至2003年2月共收治AP患儿10例,现报告如下。     

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。     

小儿急性胰腺炎52例诊治体会

近年来小儿急性胰腺炎(AP)的发病率呈逐年上升趋势,其病因和临床特点与成人有所不同。自2003年1月至2005年12月本院共收治AP患儿52例,占同期住院患儿的1.08%。现将该病诊治体会报告如下。1临床资料1.1一般资料52例中男32例,女20例;年龄2～13.8岁,平均7.3岁;来自农村39例(占75.0%),城镇13例(占25.0%)。1.2临床表现腹痛47例(占90.38%),呕吐45例(占86.54%),发热38例(占73.77%),腹泻6例(占11.54%),腹胀4例(占7.69%),黄疸2例(3.85%),腹部压痛34例(占65.38%),反跳痛12例(占19.31%),腹膜刺激征4例(占7.69%),肠鸣音减弱3例(占5.77%)。1.3辅助检查…     

小儿重症胰腺炎18例诊治分析

目的 探讨小儿重症胰腺炎的临床表现及诊疗经验。方法回顾18例重症胰腺炎患儿的治疗经过,分析其临床疗效,总结治疗经验。结果18例中,13例采取非手术治疗,5例行手术治疗,均获痊愈。结论小儿重症胰腺炎宜采用以非手术治疗为主的综合治疗,治疗过程中应遵循“个体化”的治疗方案,掌握手术原则。     

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??Abstract??The incidence of pancreatitis in childhood has been rising in recent years. Either acute pancreatitis or chronic?? a main symptom is abdominal pain. Early diagnosis of these two diseases relies on the alert in a pediatrist’s mind and choosing lab and imaging examinations correctly. Otherwise?? missed or delayed diagnosis often occurs easily. Although conservative treatments have been the most important therapeutic options?? multiple disciplines of treatment can be attractive and improve prognosis of patients.     

儿童急性肾小管间质性肾炎的研究进展

儿童急性肾小管间质性肾炎(ATIN)多数是可逆的,早期诊断、及时治疗是非常重要的,可防止肾功能进一步恶化从而延长患儿生存时间并提高其生活质量.近几年ATIN来愈来愈受到专家和学者的重视,对儿童ATIN已经有了更进一步的认识.该文从儿童ATIN的病因、发病机制、诊断及治疗几方面将近几年来关于ATIN的研究进展进行综述.     

Relapsing acute and chronic pancreatitis.

Twenty five children with non-traumatic relapsing acute or chronic pancreatitis who had been followed up from five months to seven years were studied. Seven had congenital anomalies, including two with choledochal cysts and four with pancreas divisum. Alcohol related disease was suspected in one child. The importance of diabetes in two patients and a positive family history in a further three is discussed, but in 12 children no association was found. Management was similar to that for adults. Surgical intervention was required in six patients, and percutaneous drainage of pseudocysts in a further three. Outcome has generally been good.     

小儿重症急性胰腺炎的治疗

目的探讨小儿重症急性胰腺炎的综合治疗方案。方法对收治的1例小儿重症急性胰腺炎患儿进行治疗并总结其疗效。结果经采用抑制胰腺外分泌、抗感染、营养支持、中药治疗,并给予持续血液净化,患儿获得痊愈。结论小儿重症急性胰腺炎的治疗为个体化的综合治疗,持续血液净化可能提高抢救存活率,营养支持和中医治疗也是治疗的重要环节。     

儿童迁延性及慢性腹泻病因研究进展

儿童迁延性、慢性腹泻的病程为2周至2个月或超过2个月,是一组多病因导致的临床综合征。本文对其常见病因进行了综述,常见病因包括感染、非特异性炎症性肠病、食物过敏、乳糖不耐受以及抗生素相关性腹泻、神经调节异常、免疫缺陷病、营养不良、乳糜泻、锌缺乏等。     

Clinical profile and outcome of chronic pancreatitis in children

Objective

To evaluate the etiology, presentation, complications and management of chronic pancreatitis in children.

Design

Retrospective chart review.

Setting

Gastroenterology department at Christian Medical College and Hospital, Vellore, India between January 2005 and December 2010.

Participants

99 Children (<18 yrs) diagnosed with chronic pancreatitis based on clinical and imaging features.

Main outcome measures

Etiology, clinical presentation, complications and management of chronic pancreatitis in children.

Results

Of 3887 children who attended the Gastroenterology department, 99(2.5%) had chronic pancreatitis, of which 60 (60.6%) were males. In 95(95.9%) patients no definite cause was detected and they were labeled as Idiopathic chronic pancreatitis. All patients had abdominal pain, while 9(9.1%) had diabetes mellitus. Of the 22 children tested for stool fat, 10(45.5%) had steatorrhea. Pancreatic calcification was seen in 69 (69.7%). 68 (71.6%) patients with idiopathic chronic pancreatitis had calcification. Calcific idiopathic chronic pancreatitis was more frequent in males (67.6% vs. 48.1%, P=0.07), and was more commonly associated with diabetes mellitus (13.2% vs. none, P=0.047) and steatorrhea (61.5% vs. 16.7%, P=0.069). Pseudocyst (17.1%) and ascites (9.1%) were the most common complications. All children were treated with pancreatic enzyme supplements for pain relief. 57 patients were followed up. With enzyme supplementation, pain relief was present in 32 (56.1%) patients. Of those who did not improve, 10 underwent endotherapy and 15 underwent surgery. Follow up of 8 patients who underwent endotherapy, showed that 5 (62.5%) had relief. Follow up of 11 patients who underwent surgery showed that only 3 (27 %) had pain relief. There was no death.

Conclusions

Idiopathic chronic pancreatitis is the predominant form of chronic pancreatitis in children and adolescents. It can present with or without calcification. The calcific variety is an aggressive disease characterized by early morphological and functional damage to the pancreas.