小儿重症急性胰腺炎的超声表现

目的：总结小儿重症急性胰腺炎（SAP）超声特征及病因。方法：回顾性分析65例经临床确诊或尸检证实为SAP患儿的超声声像特征及临床资料。结果：小儿SAP的超声声像表现：胰腺不同程度的肿大，甚至形态失常，边缘不规整；回声可增强，可减低，或强弱不等；胰周、腹腔各个腔隙积液及假性囊肿形成较多见；原发性SAP胰腺可形态失常，无局限性肿大，回声强弱不等或减低，无回声增强，假性囊肿较多见；继发性SAP（外伤性SAP除外）胰腺无形态失常，可局限性肿大，胰腺回声增强，无回声减低，不伴有假性囊肿。65例SAP中，外伤28例（43.1%），感染18例（27.6%），特发性15例（23.2%），全身性非感染性疾病3例（4.6%），术后应激反应1例（1.5%）。结论：超声能较准确的发现小儿SAP的胰腺声像改变，可协助临床早期诊断和判断病因，从而有效降低患儿的病死率。

Ultrasonographic manifestations of severe acute pancreatitis in children

Objective: To review the ultrasonographic characteristics and causes of severe acute pancreatitis (SAP) in children. Methods: The ultrasonographic findings and clinical data of 65 children with SAP that was confirmed by clinical diagnosis or autopsy were retrospectively analyzed.Results: Ultrasonographic manifestations of SAP in children were demonstrated as follows: the pancreases were enlarged to varying degrees, or even to an abnormal shape, with irregular or ill-defined margins; the echo patterns of the pancreas were diverse which included hyperechogenicity, hypoechogenicity or heterogeneous echogenicity; fluid collections in the peripancreatic space and spaces in the abdominal cavity as well as pseudocyst formation were frequently seen; the pancreas of primary SAP presented an abnormal shape and diffuse swelling, with heterogeneous or decreased but no increased echogenicity, and was frequently associated with pseudocyst formation; in secondary SAP, with exception of traumatic SAP, the pancreas had no abnormal shape but showed the presence of localized swelling , with enhanced but no decreased echogenicity, and was not complicated by pseudocyst formation. Among the 65 children, the csuse of SAP was trauma in 28 cases (43.1%), infections in 18 cases (27.6%), idiopathy in 15 cases (23.2%), systemic non-infectious diseases in 3 cases (4.6%), and post-operative stress response in 1 case (1.5%). Conclusion: Ultrasonography can accurately find the imaging changes of the pancreas in children with SAP, which can help make an early diagnosis and judgment of its causes, and thereby effectively reduce the mortality in these children.