儿童急性胰腺炎的病因和诊治探讨

目的探讨儿童急性胰腺炎(AP)的发病特点.方法回顾36例AP患儿的临床资料进行病因、临床表现、实验室检查及影像学、治疗的分析.结果儿童AP的病因:胆结石5例,胆总管囊肿6例,胆总管下端梗阻性病变2例,胰头占位性病变1例,胰管多发性结石1例,流行性腮腺炎并发AP 1例,恶性淋巴瘤左旋门冬酰胺酶诱导化疗中并发AP 2例,坏死性淋巴结炎并发急性坏死性胰腺炎1例.可能诱发因素:病前进食油腻食物或暴饮暴食4例,有家族史1例,无明显诱因12例.临床分型:轻型急性胰腺炎(MAP)33例,重型急性胰腺炎(SAP)3例.转归:3例因经济原因自动出院,1例死亡,其余均治愈.结论儿童AP的病因以胆道疾病和特发性为主,胰腺病变一般较轻,预后良好.B超、CT和ERCP、MRCP检查对于发现病因和临床分型至关重要.对儿童AP尚需制订合理的诊疗常规.

Etiology, Diagnoses and Treatment of Childhood Acute Pancreatitis

Objective To discuss the clinical characteristics of childhood acute pancreatitis. Methods Thirty-six patients with acute pancreatitis hospitalized from Nov.1998 to May.2005.were analyzed with regard to characteristics of etiologies,clinical presentations,laboratory data,imaging feature and treatment. Results Etiological factors of childhood acute pancreatitis:gallstone(n=5),choledochal cyst(n=6),obstruction of inferior choledochous duct(n=2),caput pancreatic lesion(n=1),multiple calculi in the pancreatic duct(n=1),complication of epidemic parotitis(n=1)complication of malignant lymphoma treated with lasparaginase(n=2),to be complication of necro-(tic) lymphnoditis(n=1).Causative factors were oily food or overeating(n=4),family heredity(n=1),absence of predisposing factors(n=12).Clinical classification:mild acute pancreatitis(MAP)(n=33),severe acute pancreatitis(SAP)(n=3).Turnover: discharge because of short of money(n=3),dead(n=1),the other were cured.(Conclusion)Biliary diease is a frequent cause of childhood acute pancreatitis.The pathological changes of pancreas are slight.The prognosis is good.Ultrasonography,computed tomogram,ERCP and MRCP are essential investigations in the determination etiology and clinical classification of childhood acute pancreatitis.Adequate and correct management is mandatory.