摘要
目的 分析儿童急性胰腺炎的临床特点,为临床及时认识和早期诊治提供依据.方法 收集我院2003年3月至2009年12月,收治的121例儿童急性胰腺炎患儿,对其临床、生化、影像学及预后进行总结和分析.结果 121例学龄前和学龄儿童为主,发病高峰季节为5、6月份,临床首发症状主要为腹痛（88.4%）和呕吐（61.2%）,1岁以下无腹痛主诉.70.2%有腹部压痛,可伴腹肌紧张、腹胀、肝大、黄疸等,严重者出现休克、抽搐、昏迷等.114例（94.2%）患儿入院24 h血淀粉酶升高,77例（79.4%）尿淀粉酶升高,发病后3 d血淀粉酶逐步下降,部分发病后14 d仍不能恢复正常.血淀粉酶持续增高和≥正常值上限3倍组患儿发热、呕吐、腹胀较多,胰腺B超或CT异常也较多,显示胰腺回声减低或增强、胰体增大、胰管扩张等.B超显示75例（62.0%）合并胰外损害,以肝脏和肠道表现为主,实验室检查肝功能异常和心肌损害较为常见,可有血清ALT或AST、总胆红素、血糖升高和心肌酶异常.部分胃镜检查显示胃黏膜充血、水肿和散在片状糜烂等.除1例剖腹探查术外,其余均非于术综合治疗,治愈好转119例,死亡2例,出院后复发5例.结论 儿童急性胰腺炎多以消化道症状为主,常合并胰外损害,婴儿腹痛主诉越少,提示临床不能解释的腹痛和呕吐患儿应考虑本病.动态监测血淀粉酶和影像学检查.
Objective To analyze the characteristics of children with acute pancreatitis and provide the basis of early diagnosis and treatment. Methods Totally 121 children with acute pancreatitis admitted to Hunan Children＇s Hospital between March 2003 and December 2009 were enrolled in this retrospective study. The data of clinical manifestations, biochemical examinations, imaging and prognosis were summarized and statistically analyzed. Results Of the 121 cases, preschool and school-age children were the main groups, and the prevalent months were May and June. Abdominal pain （ 88. 4% ） and vomiting （61.2%） were the major initial symptoms of pancreatitis in children, but none of children under the age 1year complained of abdominal pain; 70. 2% had signs of abdominal tenderness, accompanied by abdominal rigidity, distension, hepatomegaly, jaundice, etc. Severe patients developed shock, convulsions, coma and so on. Serum amylase concentration increased to above the upper reference limit in 114 children （94. 2% ）when they admitted within 24 hours after admission. Urine amylase elevation was noted in 77 children（79.4%）. The amylase concentration decreased after 3 days, but not all returned to normal 14 days afterward. Children with sustained serum amylase elevation or serum amylase level ≥ 3 times upper limit of normal range more likely to have fever, vomiting, abdominal distension, and pancreatic abnormalities at ultrasonography or CT which showed that the echo of pancreas decreased or enhanced, pancreas edema,pancreatic duct expanded, etc. Abdominal ultrasonography and CT showed that 75 cases （ 62. 0% ） had other organ damage besides pancreatitis, liver （25. 3% ） and intestinal （16. 0% ） damages were very common, while liver and myocardial damages were seen frequently in the laboratory examinations, which complicated with serum ALT/AST, total bilirubin, blood glucose elevation and myocardial enzyme abnormalities. Several gastroscopic examinations showed mucosal hyperemia and edema, sheet-like erosion,etc. Except for one case who underwent laparotomy, all the remaining children were treated with nonoperative comprehensive treatment. Of them 119 were cured or improved, 2 died and 5 had recurred disease later. Conclusions Gastrointestinal symptoms were the main clinical manifestations of acute pancreatitis in children, often complicated with extrapancreatic damage. The younger the patient was, the less complaint of abdominal pain they had. This indicates that acute pancreatitis should be considered when children suffered from acute abdominal pain and vomiting which had no known cause or could not be explained. It is important to do take serial monitoring of serum amylase, and imaging procedures.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2011年第1期10-16,共7页
Chinese Journal of Pediatrics
关键词
胰腺炎
急性坏死性
淀粉酶类
儿童
Pancreatitis, acute necrotizing
Amylases
Children
