儿童急性胰腺炎与成人急性胰腺炎的区别

急性胰腺炎(AP)是常见的急腹症之一,多见于青壮年,儿童AP并不常见.成人AP根据症状和体征诊断相对容易,而儿童AP临床表现多种多样,且叙述不清,常被误诊或漏诊.儿童AP在发病率、病因、临床表现等方面与成人AP存在较为明显的区别.     

左旋门冬酰胺酶诱发儿童急性胰腺炎19例分析

目的：分析左旋门冬酰胺酶（L-ASP）诱发急性胰腺炎的临床特点，以利早期诊断和治疗。方法：对1996-2001年应用L-ASP进行化疗方案治疗的675例次中发生急性胰腺炎的19例的临床特点、血液学和影象学及治疗预后作了总结分析。结果:L-ASP诱发急性胰腺炎的发生率为2.8%。临床表现中有腹痛17例，伴恶心17例、呕吐16例；发烧13例、腹胀13例、休克11例。首发症状中主要为腹痛，其次为休克。血液检查19例中血淀粉酶升高16例、高血糖11例、低血钠11/18例、低血钙9/18例、低蛋白血症8/16例、酸中毒7/18例及肾功能不良3例，凝血功能异常10/16例。合并症中有肝损害或脂肪肝、腹膜炎、感染。B超或CT检查;16/18例（89％）有异常。抢救休克和抑制胰酶分泌是最重要的非手术治疗措施；出血坏死性胰腺炎及早手术。19例胰腺炎中12例治愈，其中10例水肿型均痊愈；9例出血坏死型中7例死于休克。结论：结合L-ASP的用药史，监测病人腹痛或休克表现，检测血淀粉酶及腹部B超可以使早期诊断成为可能。抢救休克、抑制胰酶分泌及手术是最主要的治疗措施。     

急性坏死性胰腺炎16例

本文分析１６例小儿急性坏死性胰腺炎，指出该病临床表现不典型，血淀粉酶可以不增高，容易误诊。腹腔穿刺和腹水淀粉酶测定能提高早期诊断率。手术治疗效果好。     

小儿急性出血坏死性胰腺炎的诊断和治疗

急性出血坏死性胰腺炎(AHNP)尽管小儿发病率低,但病情重,病死率高。我院近20年来共收治小儿AHNP9例,均经手术治疗而获痊愈,现讨论如下。     

儿童急性胰腺炎肾损害临床特征

目的探讨儿童急性胰腺炎肾损害的临床、病理特点。方法对4例急性胰腺炎肾损害患儿进行肾脏活检,尿β2微球蛋白(β2-MG)、视黄醇结合蛋白(RBP),血清白蛋白、肌酐,24h尿蛋白定量等检查;所有患儿均应用糖皮质激素及免疫抑制剂联合治疗。结果急性胰腺炎肾损害患儿血尿、蛋白尿持续时间长,尿24h蛋白定量、尿β2-MG和RBP水平均升高。肾脏病理损害表现为肾间质水肿、弥漫性炎性细胞浸润,肾小球系膜细胞、基质增生,有IgG、IgE、IgA、IgM、C3等免疫复合物沉积。经皮质激素及免疫抑制剂联合治疗6～8个月缓解。结论儿童急性胰腺炎肾损害作为一种独立的继发性肾脏损害性疾病,应当引起临床的关注。     

儿童急性胰腺炎的病因与诊治近况

急性胰腺炎（acute pancreatitis，AP）以往被认为在儿科领域中甚为少见，随着对该病认识的深入，近年来在临床上时而所见，Lopez调查报告在美国每个儿童医疗单位每年均可收治2-9例AP患儿，上海新华医院小儿外科自2001年3月～2003年9月共收治26例，几乎每年有10例以上患儿需要治疗。本文就有关病因及诊治中的有关热点问题作一简要介绍。     

早期经口进食对小儿轻症急性胰腺炎的疗效影响

目的 探讨早期经口进食对小儿轻症急性胰腺炎(pediatric mild acute pancreatitis,PMAP)的疗效影响.方法 将川北医学院附属医院小儿外科收治的36例轻症急性胰腺炎患者分为对照组(n=16)与研究组(n=20).对照组按照传统治疗方案治疗(常规禁食1～7 d,再根据腹痛症状、饥饿感、不良体...     

儿童血脂异常诱导的急性胰腺炎13例临床分析

目的探讨儿童血脂异常诱导的急性胰腺炎(AP)的临床特点。方法回顾分析2015年12月至2019年12月诊断的血脂异常诱导AP患儿的临床资料。结果确诊AP患儿62例,其中血脂异常诱导的AP 13例,占20.97%。男10例、女3例,年龄2~15岁,病程1天~1年,重型1例、轻型12例。13例血脂异常诱导的AP患儿均有腹痛;8例有恶心、呕吐;4例蛋白质能量营养不良;1例休克;1例伴脂肪瘤,肝脾肿大,红细胞、白细胞及血小板下降;2例肥胖;1例糖尿病。高三酰甘油血症4例、高胆固醇血症4例、混合性高脂血症3例、低高密度脂蛋白胆固醇2例。3例行全外显子基因检测,2例LPL基因变异,确诊为家族性高乳糜微粒血症。10例影像学异常,其中9例B超有胰腺炎改变,8例MRCP示胰腺增大。治疗包括饮食管理、抑酸及生长抑素等,2例静滴左卡尼汀及口服烟酰胺片治疗;1例重型AP抗休克治疗。13例均临床缓解,1例出院后2周进食大量鱼汤复发。结论血脂异常诱导的儿童AP并不罕见,规范的饮食指导是治疗的重要措施之一。     

小儿急性出血坏死性胰腺炎3例误诊分析

1　病例资料　　例 1,男 ,9岁 ,因“腹痛 7ｈ ,腹泻 1次” ,以“胃肠炎、中毒型菌痢”收入院 ,入院查体 :重病容 ,气促 ,唇周发绀 ,腹稍胀 ,中上腹轻压痛 ,无反跳痛、肌紧 ,喜按 ,四肢凉 ,甲床发绀 ,脉细弱。检查 :ＷＢＣ 12 .4× 10 9/Ｌ ,血淀粉酶 5 0 3苏氏单位 (Ｕ) (本院正常值 6 0～ 16 0Ｕ) ,腹穿抽出淡红色液体 ,术中证实为急性出血坏死性胰腺炎(ＡＨＮＰ) ,行腹腔引流术 ,住院 10ｄ ,治愈出院。例 2 ,女 ,2岁 ,因“哭吵 1天伴频繁呕吐” ,以“阑尾炎穿孔、腹膜炎”收入院 ,查体 :急性病容 ,面色差 ,腹部膨隆 ,腹壁张力轻度增高 ,有…     

儿童急性胰腺炎的诊治进展

儿童急性胰腺炎（acute pancreatitis，AP）较少见，近年来有增多趋势，病死率较高，约为9．7％。为进一步引起临床医生对此病的重视，本文就儿童急性胰腺炎的诊治进展作一综述。[第一段]     

短时静-静脉血液滤过在小儿重症急性胰腺炎治疗中的应用

目的 探讨短时静-静脉血液滤过(SVVH)在小儿重症急性胰腺炎治疗中的策略和疗效.方法 将我院2006年5月至2010年5月收治的27例小儿重症急性胰腺炎患儿按治疗方法分为常规治疗组(A组)和常规治疗+SVVH组(B组),对其血液滤过参数、临床疗效、并发症和住院费用进行统计分析.结果 治疗后3 d与治疗前相比,在A组内,WBC(20.5±3.8)×109/L比(14.3±2.7)×109/L、AMS(781.6±187.5)U/L比(603.2±113.1)U/L、BUN(11.1±2.7)mmol/L比(8.4±1.8)mmol/L、CRP(294.5±37.7)mg/L比(171.5±34.5)mg/L、血Ca2+(1.6±0.4)mmol/L比(2.2±0.2)mmol/L、Na+浓度(128.0±6.0)mmol/L比(137.1±2.9)mmol/L及PaO2(73.9±12.1)mmHg比(85.2±5.3)mmHg等方面差异具有统计学意义(P＜0.01),UAMY(2606.9±963.9)U/L比(1782.2±878.0)U/L的差异具有统计学意义(P＜0.05);在B组内,WBC(20.1±4.8)×109/L比(9.4±3.2)×109/L、AMS(815.8±186.9)U/L比(280.1±93.9)U/L、UAMY(2706.1±961.2)U/L比(948.2±719.7)U/L、BUN(11.3±1.7)mmol/L比(5.2±2.4)mmol/L、CRP(301.9±48.7)mg/L比(87.3±34.2)mg/L、血Ca2+(1.8±0.4)mmol/L比(2.3±0.1)mmol/L、Na+浓度(127.0±6.7)mmol/L比(140.3±3.0)mmol/L及PaO2(74.7±10.4)mmHg比(93.3±5.7)mmHg,差异均有统计学意义(P＜0.01),K+(5.5±1.5)mmol/L比(4.5±0.6)mmol/L的差异具有统计学意义(P＜0.05);两组间在治疗后3 d相比,WBC(14.3±2.7)×109/L比(9.4±3.2)×109/L、AMS(603.2±113.1)U/L比(280.1±93.9)U/L、BUN(8.4±1.8)mmol/L比(5.2±2.4)mmol/L及CRP(171.5±34.5)mg/L比(87.3±34.2)mg/L,差异具有统计学意义(P＜0.01),在血UAMY(1782.2±878.0)U/L比(948.2±719.7)U/L、Ca2+(2.2±0.2)mmol/L比(2.3±0.1)mmol/L、Na+浓度(137.1±2.9)mmol/L比(140.3±3.0)mmol/L和PaO2(85.2±5.3)mmHg比(93.3±5.7)mmHg间的差异具有统计学意义(P＜0.05),而血K+浓度(4.9±1.0)mmol/L比(4.5±0.6)mmol/L的差异无统计学意义(P＞0.05).两组在腹痛缓解时间、AMS恢复正常时间、住院天数和住院费用上差异有统计学意义(P＜0.01),治疗效果、治疗3 d后John评分上的差异也有统计学意义(P＜0.05).结论 药物联合早期SVVH治疗小儿急性胰腺炎效果满意.

Abstract：

Objective To review the strategy and therapeutic effect of short term venous-venous hemofiltration (SVVH) in the treatment of severe acute pancreatitis (SAP) in children. Methods Thirty-nine children with SAP hospitalized between May 2006 and May 2010, were treated with two therapeutic strategies; routine management (Group A) and routine combined with SVVH treatment (Group B). The biochemical indicators, clinical effects, complications, cost and hospitalization duration were analyzed retrospectively. Results Comparing the data at the onset with those after threedays therapy, the biochemical indicators including WBC counts, AMS, UAMY, BUN, CRP, Ca2+ ,Na+ and PaO2 significantly improved in group A (P＜0. 01). In group B, all the biochemical indicators (WBC Counts, AMS, UAMY, BUN, CRP, Ca2+ , K+ , Na+ , PaO2 ) showed statistically significant differences (P＜0.05). Between the two groups, some of the day 3 results, including WBC,AMS, CRP, showed significant differences(P＜0.01). The level of UAMY, Ca2+, Na+ and PaO2also showed statisticcal differences (P＜0. 05), but there were no difference in K+ (P＞0. 05). With respect to the disappearance of abdominal pain and return to normal of AMS, the cost and hospitalization, the differences between the two groups was significant (P＜0. 01) Treatment effects and John's scoring on day 3 also demonstrated statistically significant differences (P＜0. 05). Conclusions The strategy of routine combined with SVVH is a viable treatment for severe acute pancreatitis of children.     

危重患儿合并胰腺损害13例报告

目的 分析危重患儿合并胰腺损害病例的病理和临床资料,总结危重患儿并发胰腺损害和坏死的临床特点和生物学标志,为危重患儿合并胰腺损害的早期诊治提供依据.方法 回顾分析2003年至2009年经本院病理解剖证实的13例胰腺损害病例的临床表现、各脏器损害的病理学结果.结果 均为急性起病,7例发热.2例出现腹痛,余病例均有腹部异常表现,如腹胀、肝脾大、肠鸣音减弱、腹腔积液、肠梗阻、消化道出血等.所有患儿存在肝功能损害,以ALT或AST升高、以白蛋白降低最为明显.9例血糖异常,5例CRP升高.腹部B超无l例显示胰腺异常声像.尸检证实7例胰腺存在不同程度的坏死,其余6例呈水肿、出血、炎症改变,并伴肾上腺、肝、肺、心、脾、肾、肠、胸腺、纵隔和肠系膜淋巴结等损害表现.患儿均在病情变化后36 h内死亡.结论 危重患儿并发胰腺损害或胰腺坏死时,起病急,来势凶猛,病程短,易发生休克和多器官损害或哀竭而死亡,儿科医师应高度警惕.

Abstract：

Objective To analyze the pathological reports and clinical data of the cases with pancreatic damage in critically ill children, and summarize the clinical features and biological markers of critically ill children with pancreatic damage or pancreatic necrosis so as to provide the basis for early diagnosis and treatment in children complicated with pancreatic damage. Methods The clinical data of 13patients treated in our hospital from 2003 to 2009 whose autopsy confirmed pancreatic damage existed and the pathological results of all organs were collected and analyzed. Results All the cases had acute onset; 7cases had fever, 2 had abdominal pain, the other cases had abdominal distention, hepatosplenomegaly,hypoactive bowel sounds, ascites, intestinal obstruction and gastrointestinal bleeding, etc. All these cases had abnormal liver function, especially elevated ALT or AST level and significantly decreased albumin, 9cases had abnormal blood glucose, 5 cases had elevated C-reactive protein (CRP). In abdominal B-mode ultrasonography, no case showed abnormal pancreas acoustic image. Autopsy confirmed that 7 cases had varying degrees of necrosis of the pancreas, other 6 cases showed edematous, hemorrhagic or inflammatory changes, which may be associated with adrenal gland, liver, lung, heart, spleen, kidney, intestine,thymus, mediastinal and mesenteric lymph nodes and other damage. All these children died within 36 hours after the patients' conditions worsened. Conclusions Pancreatic damage or necrosis in critically ill children had acute and ferocious onset, short course and were prone to multiple organ damage or failure to which all pediatric clinicians should have high alert.     

Severe acute pancreatitis in a child with phenylketonuria

We report for the first time severe acute pancreatitis in a child treated for phenylketonuria (PKU) discovered on neonatal screening. This 2-year-old boy was first hospitalized for bilious vomiting and moderate back pain. Laboratory values included a lipase level of 1.142 U/L, a phenylalanine level of 10 mg/dL, and computed tomography revealed Balthazar grade E pancreatitis. Continuous enteral feeding was started on the 3rd day after admission. We observed clinical and biological improvement. Etiologic investigations for pancreatitis returned negative. Despite the severity of the pancreatitis, we did not observe decompensation of the metabolic disease. Specific nutritional management was necessary.     

儿童急性巨核细胞白血病9例分析

目的分析儿童急性巨核细胞白血病患者的临床特征、免疫表型、细胞遗传学特征,为临床诊断及进一步治疗提供相关依据。方法对我院确诊的9例急性巨核细胞白血病患者的临床表现、实验室检查进行分析。结果9例发病年龄均小于3岁,男∶女为7∶2,89%患者急性起病,89%患者因出血就诊。肝大患者占78%,所有患者均出现重度血小板减少,中度贫血患者占89%。骨髓幼稚巨核细胞均大于20%。所有患者肿瘤细胞均表达CD41抗原。3例患者伴有染色体复杂核型异常。本组患者均失访。结论1.本病临床是以出血、肝脏肿大为主要表现,其发病年龄小,急性起病、男性较多见。2.常伴血小板重度减少,免疫标记CD41细胞是急性巨核细胞白血病快捷的诊断方法,本病可伴有复杂核型。3.预后差。     

Acute pancreatitis in children

Aim: To identify clinical, laboratory, and imaging characteristics associated with severe acute pancreatitis in children. Methods: This was a retrospective study of children under 18 years of age with acute pancreatitis between September 1993 and August 2008. Severity of pancreatitis was graded according to established criteria. Clinical, laboratory and radiological data for mild and severe pancreatitis were collected for analysis. Results: There were 180 cases of pancreatitis; 51 (28.3%) met criteria for severe disease. Severe pancreatitis was most commonly associated with systemic disease (22 of 51; 43.1%) and trauma (13 of 51; 25.4%). Patients with severe pancreatitis had significantly higher body weight, higher frequency of dyspnoea and pleural effusion, and lower serum calcium and albumin levels. Ten patients with systemic disease died; four of them had systemic lupus erythematosus (SLE). Computed tomography (CT) was more accurate than ultrasound in evaluation of the severity of pancreatitis. Conclusions: Acute pancreatitis in children is associated with significant morbidity and mortality. The severity of paediatric pancreatitis may be influenced by aetiology. CT is recommended for evaluation of severity of pancreatitis.     

儿童重症急性胰腺炎的特点与治疗

儿童急性胰腺炎病因主要包括感染、药物诱导、外伤和先天性胆道畸形等.儿童胰腺炎发病率低于成人,但呈增多趋势,至今儿童重症急性胰腺炎(severe acute pancreatitis,SAP)仍鲜有资料可循.腹痛和呕吐是SAP早期主要症状,也可能以休克或多器官功能障碍起病.目前仍没有适合儿童SAP病情严重程度的评分标准,有限资料认为入院24h血液脂肪酶升高程度、白蛋白水平和WBC计数有助于病情和预后的判断.血液净化可以有效减轻炎症反应、改善器官功能和稳定液体平衡,可能是儿童SAP新的有潜力的治疗措施.     

Successful conservative management of idiopathic fibrosing pancreatitis in children

Idiopathic fibrosing pancreatitis, a rare cause of obstructive jaundice and abdominal pain in children, which has certain features in common with the emerging entity of autoimmune pancreatitis as described in adults, has frequently been managed surgically. We present our experience of successful conservative management of this condition in children. Three children (6–12 years; two girls, one boy) presented with a short history of abdominal pain followed by obstructive jaundice. Abdominal ultrasonographic examination in each case showed dilated intrahepatic and common bile ducts with a bulky pancreas, predominantly the head. These findings were confirmed by magnetic resonance imaging. In two cases, the diagnosis of fibrosing pancreatitis was made by exclusion after extensive investigation. The third case had a percutaneous ultrasound-guided pancreatic needle biopsy. Two patients were managed by supportive medical therapy alone, whilst the third, with symptomatic obstructive jaundice, underwent temporary endoscopic stenting of the common bile duct. Cases have been followed-up for 12–49 months. There was complete clinical and biochemical resolution of obstructive jaundice in all three cases. Plasma bilirubin concentrations decreased to normal within 3–8 weeks. Serial abdominal imaging showed a gradual resolution of biliary dilatation and abnormal pancreatic morphology with subsequent pancreatic atrophy. Two children developed steatorrhoea that responded to pancreatic enzyme supplements, and one patient developed diabetes mellitus. None of the cases needed invasive surgery for diagnosis or management. Conclusion: With careful radiological and biochemical assessment and monitoring, invasive surgery can be avoided in the management of fibrosing pancreatitis. The eventual outcome is no different from reported surgically treated cases.     

儿童重症急性胰腺炎的诊治进展

儿童重症急性胰腺炎的发病率较低,起病急骤凶险,且症状不典型,有些症状缺乏特异性,病死率相对较高.本文将对重症急性胰腺炎的诊断、治疗进展作一综述.     

嗜酸细胞性胃肠炎合并急性胰腺炎1例并文献复习

目的 提高对儿童嗜酸细胞性胃肠炎（EG）的认识。方法 报告1例EG合并急性胰腺炎患儿的诊断和治疗过程,系统检索文献并汇总复习类似病例相关报道,分析总结EG合并急性胰腺炎的临床特征。结果 男,14岁,以“反复腹痛、腹泻1周”主诉入院。初步诊断为急性胰腺炎,入院后查血嗜酸性粒细胞（EOS）0.62,血清IgE 393 U·mL-1,骨髓细胞学检查示EOS比例增加,内镜下显示胃肠道黏膜慢性炎症,病理活检显示十二指肠黏膜EOS浸润,诊断为EG。经泼尼松抗炎和抗过敏药物等治疗1周后病情缓解,血EOS降至正常,随访2年患儿病情稳定无反复。在万方、中国知网、EMBASE和PubMed等数据库系统检索相关文献11篇,汇总EG合并急性胰腺炎14例（儿童病例4例）,均以急性胰腺炎表现起病而误诊,以腹痛、恶心和呕吐等非特异性临床表现为主,外周血EOS均明显升高,腹腔积液EOS比例对诊断EG合并急性胰腺炎有重要提示意义,14例均有不同程度的胃、十二指肠黏膜异常改变。13例明确诊断后接受糖皮质激素治疗预后良好;1例手术切除胰腺后复发,诊断EG后予糖皮质激素治疗缓解。结论 EG合并急性胰腺炎罕见,对不明原因急性胰腺炎,且伴血EOS增多或常规抑酶抑酸治疗后临床转归差者,应警惕EG可能,完善内镜病理活检可以明确诊断。