摘要
目的探讨儿童胆源性胰腺炎(acute biliary pancreatitis,ABP)的早期诊断、中西医结合治疗和预防方法,提高儿童胆源性胰腺炎诊断和治疗的成功率。方法通过1例典型儿童ABP病例分析,对诊断、鉴别诊断、辅助检查特点、早期中西医结合治疗和手术方式选择等进行总结。结果儿童急性胰腺炎(acute pancreatitis,AP)多见于病毒感染引起,胆源性因素较少,易引起误诊、漏诊和误治;成人ABP最常见于胆道结石,而儿童常见于先天性胆道发育异常,如先天性胆总管囊肿,当某些因素(如剧烈运动等)导致胆汁逆流入胰管,引起AP的发生;儿童ABP突然起病,早期出现呕吐和嗜睡等神经系统症状,易误诊为神经系统疾病。彩色超声、腹部CT能早期发现胰腺和先天性胆道囊肿的异常影像学表现,为儿童诊断ABP常用和可靠的手段;儿童ABP早期中西医结合治疗,可降低其并发症发生和死亡率,根据病情选择合适的手术时机。结论儿童ABP具有其自身特点,临床医生应提高对ABP的认识,建议儿童健康体检时进行影像学的筛查,发现先天性胆道畸形,应及早进行相应的治疗干预,可有效防止本病的发生。
Objective To investigate the early diagnosis,integrated Chinese and Western medicine treatment and prevention of acute biliary pancreatitis(ABP)in children,and to improve the success rate of diagnosis and treatment.Methods A typical pediatric case of ABP was analyzed,and the diagnosis,differential diagnosis,auxiliary examination characteristics,early integrated Chinese and Western medicine treatment,and the choice of surgical methods were summarized.Results Acute pancreatitis(AP)in children was more commonly caused by viral infection than that of biliary factors.Misdiagnosis,missed diagnosis and mistreatment were prone to occur in children with AP.In adults,ABP was mainly caused by biliary stones;while in children,it was usually caused by congenital biliary dysplasia like congenital choledochal cyst.When certain factors like strenuous exercise led bile to reflux into the pancreatic duct,AP occurred.ABP in children was featured by a sudden onset,manifesting as early neurological symptoms like vomiting and lethargy,which was easy to be misdiagnosed as a neurological disease.Color Doppler ultrasound and abdominal computed tomography(CT)contributed to visualize abnormal imaging findings of pancreatic and congenital biliary cysts,which were common and reliable diagnostic tools of ABP in children.Early treatment of ABP in children with integrated Chinese and Western medicine treatment could reduce the incidence of complications and mortality,and an appropriate time of operation should be individually determined.Conclusion ABP in children has its own characteristics.Clinicians should improve the understanding of ABP.It is recommended to carry out imaging screening in children's health examination,aiming to find out congenital biliary malformations,and to carry out corresponding treatment interventions as early as possible,which can effectively prevent the occurrence of ABP.
作者
陈聪水
李园
陈淑芳
Chen Congshui;Li Yuan;Chen Shufang(Department of Pediatrics,Sanming Integrated Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Sanming 365001,China;Department of Pediatrics,Qingliu County General Hospital,Qingliu 365300,China)
出处
《临床荟萃》
CAS
2023年第8期726-730,共5页
Clinical Focus
关键词
胰腺炎
诊断
中西医结合治疗
儿童
胆总管囊肿
pancreatitis
diagnosis
integrated Chinese and Western medicine treatment
children
choledochal cyst
