摘要
的探讨儿童Ⅲ型胰腺外伤的治疗方法。方法回顾性分析2010年1月至2015年6月收治的6例Ⅲ型胰腺外伤患儿的临床资料。本组均为男孩，年龄6岁4个月-11岁5个月。入院时均有不同程度腹痛，伴呕吐2例，伴发热1例；血淀粉酶（695．83±264．07）U／L，尿淀粉酶（4163．67±5546．53）U／L。CT检查，均提示胰管损伤可能，其中3例分别合并脾挫伤、左肾上腺挫伤加肺挫伤、左肾上腺挫伤。患儿均先给予生长抑素、禁食、静脉营养等保守治疗，但症状控制不满意。待血流动力学稳定后行逆行胰胆管造影（ERCP）加内镜鼻胰管引流术或胰管支架引流术。结果6例ERCP造影提示1例胰头部、4例胰体部、1例体尾部主胰管损伤。行13次ERCP引流，2例经7次ERCP引流治愈；另4例6次ERCP引流症状控制不佳，3例穿刺引流，1例开放引流后治愈。6例随访胰管均修复、恢复通畅；2例超声检查示胰腺有局部细小囊性改变，无临床症状，淀粉酶恢复正常。结论单独ERCP引流治疗儿童Ⅲ型胰腺外伤疗效不满意，有待更多临床总结；结合经皮穿刺引流和开放引流效果确切。儿童Ⅲ型胰腺外伤使用药物治疗加确切引流就能取得良好预后，应尽量避免复杂手术。
Objective To explore the management of type llI pancreatic trauma in children. Methods Retrospective reviews were conducted for the clinical data of 6 male cases of type Ill pancreatic trauma from January 2010 to June 2015. Their age range was 6 years 4 months to 11 years 5 months. Varying severity of abdominal pain was accompanied by vomiting （n = 2） and fever （n = 1）. Serum and urine amylases were （695.83 ± 264. 07） U/L and （4 163. 67 ± 546. 53） U/L. Abdominal CT was performed in all cases before admission and 3 cases had concurrent splenic contusion, left adrenal gland ＆ pulmonary contusion and left adrenal gland contusion respectively. Such conservative measures as somatostatin dosing, fasting and parenteral nutrition were provided without obvious improvement in clinical symptoms. Endoscopic retrograde cholangiopancreatography （ERCP）, nasal- pancreatic catheter drainage （ENPD） and endoscopic retrograde pancreatic drainage （ERPD） were performed after hemodynamic stabilization. Results Pancreatic head trauma （n = 1）, pancreatic body trauma （n = 4） and pancreatic body ＆ tail tail pancreatic duct trauma （n = 1） were detected by ERCP. Two cases were cured successfully by 7 sessions of ERCP and ERPD while another 4 cases responded well to 6 sessions of ERCP and percutaneous catheter drainage （PCD） or Open drainage （OD）. During follow-ups, pancreatic duct was repaired （n = 6） and tiny cystic lesions were detected by ultrasound （n = 2）. Conclusions ERCP drainage alone is insufficient for managing type I]I pancreatic trauma in children. And more clinical trials are needed. PCD and OD are effective so that complex operation should be avoided as much as possible.
出处
《中华小儿外科杂志》
CSCD
2016年第9期687-690,共4页
Chinese Journal of Pediatric Surgery
关键词
胰腺
胰胆管造影术
内窥镜逆行
治疗结果
Pancreas
Cholangiopancreatography, endoscopic retrograde
Treatment outcome
