以大量血性胸腔积液为表现的儿童胰腺胸膜瘘1例报告并文献复习

目的探讨儿童胰腺胸膜瘘(PPF)导致大量血性胸腔积液的临床特点及诊治。方法回顾分析1例PPF导致右侧大量血性胸腔积液患儿的诊治经过,并检索截至2018年8月的中文数据库及PubMed数据库进行文献复习。结果8岁女孩,间断呼吸困难20余天。CT示右侧大量胸腔积液及慢性胰腺炎征象。经对症治疗后胸腔闭式引流管仍持续有血性液体引出,胸腔积液淀粉酶最高达56 365.7 U/L。经再次影像学检查发现存在PPF,予内镜下行逆行胰胆管造影术(ERCP)及逆行胰管支架引流术,治疗好转出院。文献检索到中英文文献各6篇,共计18例儿童PPF,多以呼吸困难或胸闷(13例)、腹痛(10例)为主要表现,除2例未详细报道外其余病例胸腔积液淀粉酶/脂肪酶均升高,分别通过CT、磁共振胰胆管造影、ERCP、手术探查确诊,经手术、ERCP介入或保守治疗有效。结论PPF是罕见的儿童胰腺并发症,肺部症状显著,应尽早进行胸腔积液淀粉酶检测,并积极寻找瘘管,经治疗预后大多良好。

Massive hemorrhagic pleural effusion caused by pancreaticopleural fistula in children: a case report and literature review

Objective To explore the clinical characteristics,diagnosis and treatment of massive hemorrhagic pleural effusion caused by pancreaticopleural fistula(PPF)in children.Method The diagnosis and treatment of a child with massive right-sided hemorrhagic pleural effusion caused by PPF was retrospectively analyzed.The Chinese databases and PubMed databases were searched up to August 2018 for literature review.Results An 8-year-old girl suffered from intermittent dyspnea for more than 20 days.CT showed massive pleural effusion at the right side and signs of chronic pancreatitis.Although symptomatic treatment was given,bloody fluid continued to flow out from the closed chest drainage tube,and the highest amylase in pleural effusion was 56365.7 U/L.PPF was found by second imaging examination.Endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic retrograde pancreatic drainage were performed and the girl was improved after treatment and discharged.Literature review identi fied 18 cases of PPF in children from 6 Chinese articles and 6 English articles and main manifestations were dyspnea or chest tightness(13 cases)and abdominal pain(10 cases).Except for 2 patient who was not clearly reported,amylase/lipase in pleural effusion was increased in other patients who were con firmed by CT,magnetic resonance cholangiopancreatography,ERCP and surgical exploration respectively.Surgery,ERCP intervention or conservative treatments were effective.Conclusions PPF is a rare pancreatic complication in children and has significant pulmonary symptoms.Pleural effusion amylase detection should be carried out as soon as possible,and fistula should be actively sought.After treatment,the prognosis is mostly good.