小儿假性胰腺囊肿外科治疗体会

小儿假性胰腺囊肿是较少见的疾病。随着现代影像学的进展和各种诊断手段的不断提高,大大提高了本病的确诊率。治疗的主要手段为外科手术。我院自1995年～2002年共收治小儿假性胰腺囊肿14例,均行外科手术治愈,现报告如下。1临床资料1.1一般资料本组14例,男9例(64.3%),女5例(35.7%),男女之比约2:1。年龄2岁8个月～13岁,平均8.6岁,其中2岁8个月至9岁4例(28.6%),10～13岁10例(71.4%)。发病时间4d～1年,平均5个月。有腹部外伤史11例(78.6%),急性胰腺炎病史2例(14.3%),未发现明显诱因1例(7.1%)。1.2临床表现上腹部疼痛11例(78.6%),腹胀,恶心呕吐6…     

小儿胰腺囊肿的治疗

目的　探讨真、假性胰腺囊肿临床特点及治疗。方法　对１６ 例小儿胰腺囊肿的临床特点、影像学检查及治疗进行分析。结果　真假性胰腺囊肿均有腹痛或不适,可触及包块１５ 例,穿孔性腹膜炎１ 例。 Ｂ 超均见囊性肿物,真性胰腺囊肿小,呈不规则哑铃状。１６ 例均行手术治疗,除１ 例先天性胰腺囊肿行囊肿摘除术,置管引流外,余均行横结肠肠系膜切口囊肿低位空肠 Ｒｏｕｘ － ｅｎ － Ｙ 吻合术。术后并发胰瘘１ 例。结论　真性囊肿一旦确诊,应行囊肿摘除术;假性胰腺囊肿可择期手术,如有穿孔并发腹膜炎应立即手术,手术提倡横结肠肠系膜低位切口行囊肠吻合术。     

儿童假性胰腺囊肿外科治疗探讨

目的探讨儿童假性胰腺囊肿的治疗方法,以提高疗效,改善预后。方法回顾性分析本院15年来收治的18例假性胰腺囊肿患儿临床资料,男10例,女8例,年龄4～14岁,平均年龄9岁,10例有急性胰腺炎病史,8例有外伤史,15例有上腹痛,8例扪及上腹部包块。11例行保守治疗,6例作内引流,1例作囊肿切除术。结果18例均治愈,无一例死亡,均无严重并发症发生。随访8个月至2年无复发。结论儿童假性胰腺囊肿应根据具体情况采用不同的治疗方法,手术治疗以囊肿Roux—Y吻合术为最佳。     

儿童胰腺假性囊肿的诊断与治疗方法评估

目的 探讨儿童胰腺假性囊肿的诊断与合理治疗方法。方法 对63例胰腺假性囊肿患儿的诊疗情况进行回顾性研究分析。结果 63例中血清淀粉酶升高59例(93．7％)，尿淀粉酶升高62例(98．4％)；63例均行上腹部B超检查，符合诊断57例(90．5％)，42例行CT扫描检查，符合诊断33例(78．6％)。本组非手术治愈7例，囊肿置管外引流术5例，囊肿胃后壁吻合内引流术3例，囊肿腰侧腹膜间隙引流5例，囊肿空肠Roux—YⅠ期吻合内引流术38例，Ⅱ期内引流术5例，本组病例全部治愈，术后无一例发生胰瘘。结论 尿、血清淀粉酶与B超、CT检查是诊断胰腺假性囊肿的有效方法。急性囊肿常伴有急腹症表现，应根据病程与囊肿的大小选择治疗方法，慢性假性囊肿采用囊肿与空肠Roux-Y吻合术为有效的内引流方法。     

假性胰腺囊肿的诊断和治疗

假性胰腺囊肿的诊断和治疗安阳地区医院（４５５０００）袁兆普，陈建设，郭家宝１９８８年１０月～１９９４年１２月，我们收治小儿假性胰腺囊肿１２例，疗效满意，现报告如下。临床资料一、一般资料１２例中男１１例，女１例；年龄４岁～１４岁，急诊入院者７例，１０例...     

小儿胰腺假性囊肿17例诊疗分析

目的探讨小儿胰腺假性囊肿的治疗体会。方法回顾性分析本院1999年1月至2012年12月收治的17例胰腺假性囊肿患儿临床资料,男8例,女9例,年龄2-16岁,平均年龄8．4岁,其中13例行保守治疗;1例行超声引导下经皮穿刺引流;3例手术治疗（1例行囊肿外引流术,1例行囊肿胃吻合术,1例行胰腺囊肿切除术）。结果13例保守治疗病例中,10例治疗有效;3例失败其中1例经皮穿刺引流病例好转出院。3例手术病例均治愈出院。17例中,1例复发,其余治愈及好转病例随访半年至1年均无复发及相关并发症出现。结论胰腺假性囊肿无论大小,大多数经早期保守治疗,可获好转或痊愈;出现手术适应证时应及时手术,手术治愈率高,囊肿吸收快,并发症少。     

Concentration of plasma beta-carotene in cystic fibrosis children with pancreatic insufficiency

Patients with cystic fibrosis (CF) have significantly decreased plasma concentrations of antioxidant vitamins which is considered to result both from fat malabsorption and from chronic pulmonary infection. The aim of this study was to investigate levels of vitamin A and beta-carotene in plasma of CF subjects with pancreatic exocrine insufficiency. In thirty CF patients mean plasma concentrations of vitamin A (1.17 micromol/l) was lower by 30% and that of beta-carotene (1.3 micromol/l) by 60% than in healthy children. Vitamin A level was positively correlated with beta-carotene (r=0.67; p<0.001). Ratios of beta-carotene to total cholesterol and cholesterol of LDL (low density lipoprotein) were 40% lower than in the control group. We conclude that in our CF patients the concentration of beta-carotene does not seem to be sufficient to inhibit lipid peroxidation especially of LDL fraction.     

Vitamin E status in children with cystic fibrosis and pancreatic insufficiency

Vitamin E status was compared in 69 children (7.0-10.0 years) with cystic fibrosis and pancreatic with the National Health and Nutrition Examination Survey III sample (6.0-11.9 years). With median vitamin E intakes of 6 mg/day (dietary) and 224 mg/day (supplemental), children with cystic fibrosis had higher serum alpha-tocopherol:cholesterol ratios, higher alpha-tocopherol, and lower cholesterol levels than in the National Health and Nutrition Examination Survey.     

Growth hormone treatment in children with cystic fibrosis

Children with cystic fibrosis (CF) have problems with poor linear growth and inadequate weight gain. Nutritional augmentation has been the mainstay of therapy for improving both weight and height in CF; however inadequate growth continues to be a problem. Furthermore, protein catabolism has been documented even in non-acutely ill adults and children with CF, and could adversely affect longitudinal growth. Human recombinant growth hormone (GH) has positive effects on nitrogen balance, and multiple studies have demonstrated improved height and weight in children treated with GH. The purpose of this article is to summarize studies evaluating GH use in children with CF.     

儿童肾囊性疾病的诊治

Potter分型将儿童肾囊性疾病分为4型:常染色体隐性遗传性多囊性肾病、多囊性肾发育不良、常染色体显性遗传性多囊性肾病、梗阻性囊性发育不良肾.此外,单纯性肾囊肿、发生在肾肿瘤及其他伴囊性肾病的综合征也可引起肾脏呈囊性改变.这类病由于其发病机制和病理基础不同,临床诊断及治疗方案选择亦不同,要正确诊断这类疾病,需要仔细分类并查明病因.该文就儿童常见的肾囊性疾病进行综述.     

Restoration of exocrine pancreatic function in older children with cystic fibrosis on ivacaftor

Prior to the use of cystic fibrosis (CF) modulator therapy, exocrine pancreatic insufficiency in CF was thought to be irreversible. Improvement in pancreatic function on ivacaftor has been reported in open label studies in 1–5 year olds. The mechanism by which ivacaftor might improve exocrine pancreatic function is unclear. Although the effect of ivacaftor on pancreatic function may be more significant in younger children, evidence is mounting that there may still be potential for improvement in older children on long term therapy.     

Relation between pancreatic lipase activity and gastric emptying rate in children with cystic fibrosis

OBJECTIVE: To determine whether abnormal gastric emptying is responsible for the inability of pancreatic enzyme replacement therapy (PERT) to normalize fat digestion in patients with cystic fibrosis (CF) who are pancreatic-insufficient.Study design Gastric emptying of a solid meal and pancreatic lipase function were assessed in 10 children with CF and 12 healthy control subjects with noninvasive breath tests using (13)C-octanoic acid and (13)C-mixed triglyceride, respectively. Lipase function was assessed in the subjects with CF with and without PERT. RESULTS: Without PERT, the lipase activity for the patients was less than that for the control subjects (P<.001); however, with PERT, 40% of the patients had a normalized lipase function. There were no differences between the mean gastric emptying rates of the patients with CF and the control subjects (P>.05), but there was a negative correlation between gastric half emptying time and percentage improvement in (13)C-mixed triglyceride results of the patients with CF with pancreatic enzymes compared with placebo (P<.05), with patients with slow gastric emptying having less improvement with PERT. CONCLUSIONS: The success of PERT in improving pancreatic lipase activity is reduced in patients with slow gastric emptying, which could explain the variations in improvement of fat digestion with enzyme supplementation.