天津医药

天津医药 ›› 2014, Vol. 42 ›› Issue (12): 1223-1225.doi: 10.3969/j.issn.0253-9896.2014.12.020

• 临床研究 • 上一篇    下一篇

先天性胆道扩张症术后损伤性胰腺炎的控制

颜培宏   

  1. 贵阳市儿童医院
  • 收稿日期:2014-06-24 修回日期:2014-08-09 出版日期:2014-12-15 发布日期:2014-12-15
  • 通讯作者: 颜培宏 E-mail:yanpeihong@sohu.com

Treatment of Traumatic Pancreatitis after Hepaticoenterostomy in Congenital Biliary Dilatation

  • Received:2014-06-24 Revised:2014-08-09 Published:2014-12-15 Online:2014-12-15

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摘要：

【摘要】 目的 分析胆道扩张症术后发生胰腺炎的原因， 探讨减少术后损伤性胰腺炎发生的控制措施。 方法 总结 2010 年 7 月—2014 年 3 月贵阳市儿童医院 22 例先天性胆道扩张症患者资料， 男 8 例， 女 14 例； 年龄 6 个月 ~6 岁零 9 个月 。 其中 8 例发生术后损伤性胰腺炎者为研究组， 余 14 例未发生者为对照组。 均行扩张胆总管切除、肝总管-空肠 Roux-en-Y 吻合术。 全部患儿术后均获定期门诊及电话随访， 随访时间为 3 个月 ~3 年， 对随访的患儿进行全面体检， 常规检查血、尿淀粉酶， 了解其变化， B 超检查了解胰腺恢复情况以及肝内、外胆管扩张情况。 结果 22 例中 8 例术后 1、4 d 血淀粉酶， 1、4、7 d 尿淀粉酶较其余 14 例明显升高（P < 0.05）， 同时伴低热， 白细胞增高，考虑为术后损伤性胰腺炎， 经使用胰酶抑制剂以及抗炎治疗 4~9 d 天恢复正常。 全部患儿随访生长发育良好， 2 例转氨酶偶有升高， 后逐渐好转， 无胰腺炎、逆行性胆管炎发作患儿。 B 超检查未见肝内、外胆管扩张情况。 结论 先天性胆道扩张症患儿早期接受囊肿切除、肝总管-空肠 Roux-en-Y 吻合术， 术中仔细操作， 注意囊肿减压， 中断胰胆管合流， 术后配合胰酶抑制剂治疗， 可降低术后损伤性胰腺炎发生。

关键词: 　　　胆道扩张症, 损伤性胰腺炎, 外科手术

Abstract:

[Abstract] Objective To investigate the cause of postoperative pancreatitis in Congenital Biliary Dilatation（CBD）, and to explore the preventive measures to decrease its occurrence. Methods Patients with CBD (n=22) were summarized during July 2010 - March 2014 in Guiyang children's hospital, which include 8 cases of male, 14 cases of female; Cases that developed postoperative traumatic pancreatitis were taken as experimental group. Cases that did not developed it was used as control group. Ages are from 6 months old to 6 years and 9 months old. All patients were received cyst excision and hepatic duct-jejunum Roux - en - Y anastomosis. All postoperative patients are followed up regularly in clinic and by telephone. All followed up were from 3 months to 3 years with a comprehensive physical examination, routine blood test and urine amy? lase analysis. B - ultrasonic examination was used to understand pancreas recovery as well as the expansion of bile duct in the liver. Results Among the 22 cases, the postoperative 1 st and 4th day blood amylase as well as 1 st， 4th and 7th day urine amylase in the experimental group are all higher than those in the control group with statistical difference (P < 0.05). Patients in experiment group show low thermal and high leucocyte represent postoperative traumatic pancreatitis. All pa? tients were given trypsin inhibitor and anti-inflammatory treatment who were completely recovered after 4 -9 days. All chil? dren growth developed normally, with only 2 cases of raised transaminase which were finally settled. Children showed no pan? creatitis and their ascending cholangitis, upper gastrointestinal angiography revealed no reflux gastritis. Conclusion The patients with CBD should receive surgery-cyst excision, hepatic duct-jejunum Roux-en-Y anastomosis early. During opera? tion, cysts decompression should be applied early. Besides these two procedures, interrupting pancreatic confluence and treat? ing pancreatic enzyme inhibitors postoperative can both help to decrease the occurrence of postoperative traumatic pancreatitis.

Key words: 　　　Congenital Biliary Dilatation, postoperative traumatic pancreatitis, surgery