儿童急性胰腺炎病因、临床特征及诊治的回顾性研究

目的：探讨儿童急性胰腺炎的病因、临床特征及诊治的临床特点,为其临床诊断和治疗提供参考依据。方法：回顾性分析2009年1月～2012年6月我院诊治的107例儿童急性胰腺炎患者的临床资料（病因、临床特点、症状体征、实验室检查、影像学特征、诊断证据、治疗及预后等）,综合比较儿童急性胰腺炎与成人急性胰腺炎的不同。结果：107例儿童急性胰腺炎,主要以腹痛为首发症状（81.3%）,10例出现腹胀（9.3%）,7例出现恶心或呕吐（6.5%）,其他或主诉不明确者3例（2.8%）。季节性不明显,四季可发病。PAP的原因中特发性占近40%,其次是外伤和先天性畸形,胆道结石致使的胰腺炎多发于年龄偏大儿童,药物、系统性疾病也均可导致PAP。单纯靠症状诊断PAP有困难,需结合血尿淀粉酶的变化及胰腺影像学检查的结果共同诊断。PAP的治疗强调个体化,科学,合理,及时的补液,及时的生长抑素、抗生素的使用至关重要（不同于成人急性胰腺炎）,手术也是必需的备选手段,但需注意手术适应症和时机的选择。结论：儿童急性胰腺炎的发病率呈上升趋势,其诊断和治疗均有其自身的特点,与成人急性胰腺炎并不完全相同,在临床诊断和治疗中应引起足够的重视。

Retrospective Study on the Etiology, Clinical Features, Diagnosis and Treatments of Paediatric Acute Pancreatitis

Objective： To investigate the characteristics of etiology, clinical feature, outcome, diagnosis and treatments in pediatric acute pancreatitis （PAP） and provide valuable evidences for the clinical diagnosis and treatment of PAP. Methods： The medical files of 107 patients with PAP admitted in our hospital from January 2009 to June 2012 were retrospectively studied （etiological factor, clinical characteristic, symptoms and signs, laboratory examination, imageology characteristic, diagnositic proof, therapeutics, prognosis and so on）. The differences between PAP and adult AP were synthetically analyzed and compared. Results： In 107 cases with PAP, stomachache was the main symptom of PAP（81.3%）, abdominal distension occurred in 10 cases（9.3%）, nausea or vomiting occurred in 7 cases （6.5%）, 3 patients （2.8%） had no definite chief complaints. PAP had no definite seasonality and could be met at clinic around one year, 40% PAP were idiopathic pancreatitis, followed by pancreatic wound and congenital abnormality, the reason of biliary calculi in PAP was commonly discovered among older children. Medicine and systemic diseases were also the reasons of PAP. It＇s hard to make the diagnosis of PAP only by symptoms and signs. Hemodiastase, uinary amylase and pancreatic gland imaging should be integrated to make fight diagnosis. Individualization, reasonable and prompt fluid replacement, prompt application of growth hormone release inhibiting hormone and antibiotic administration should be emphasized in the treatment of PAP, which were different from adult AP. Surgery was an essential option but it should be used appropriatly and dependend on precise surgical indication. Conclusion： The incidence of PAP increased significantly in the recent years. The diagnosis and treatments of PAP were different from those of adult AP, which should be payed more attention in clinic.