小儿重症急性胰腺炎的超声表现
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摘要
目的:总结小儿重症急性胰腺炎(SAP)超声特征及病因。方法:回顾性分析65例经临床确诊或尸检证实为SAP患儿的超声声像特征及临床资料。结果:小儿SAP的超声声像表现:胰腺不同程度的肿大,甚至形态失常,边缘不规整;回声可增强,可减低,或强弱不等;胰周、腹腔各个腔隙积液及假性囊肿形成较多见;原发性SAP胰腺可形态失常,无局限性肿大,回声强弱不等或减低,无回声增强,假性囊肿较多见;继发性SAP(外伤性SAP除外)胰腺无形态失常,可局限性肿大,胰腺回声增强,无回声减低,不伴有假性囊肿。65例SAP中,外伤28例(43.1%),感染18例(27.6%),特发性15例(23.2%),全身性非感染性疾病3例(4.6%),术后应激反应1例(1.5%)。结论:超声能较准确的发现小儿SAP的胰腺声像改变,可协助临床早期诊断和判断病因,从而有效降低患儿的病死率。
Objective:To review the ultrasonographic characteristics and causes of severe acute pancreatitis(SAP) in children.Methods:The ultrasonographic findings and clinical data of 65 children with SAP that was confirmed by clinical diagnosis or autopsy were retrospectively analyzed.Results:Ultrasonographic manifestations of SAP in children were demonstrated as follows:the pancreases were enlarged to varying degrees,or even to an abnormal shape,with irregular or ill-defined margins;the echo patterns of the pancreas were diverse which included hyperechogenicity,hypoechogenicity or heterogeneous echogenicity;fluid collections in the peripancreatic space and spaces in the abdominal cavity as well as pseudocyst formation were frequently seen;the pancreas of primary SAP presented an abnormal shape and diffuse swelling,with heterogeneous or decreased but no increased echogenicity,and was frequently associated with pseudocyst formation;in secondary SAP,with exception of traumatic SAP,the pancreas had no abnormal shape but showed the presence of localized swelling,with enhanced but no decreased echogenicity,and was not complicated by pseudocyst formation.Among the 65 children,the csuse of SAP was trauma in 28 cases(43.1%),infections in 18 cases(27.6%),idiopathy in 15 cases(23.2%),systemic non-infectious diseases in 3 cases(4.6%),and postoperative stress response in 1 case(1.5%).Conclusion:Ultrasonography can accurately i nd the imaging changes of the pancreas in children with SAP,which can help make an early diagnosis and judgment of its causes,and thereby effectively reduce the mortality in these children.
Objective:To review the ultrasonographic characteristics and causes of severe acute pancreatitis(SAP) in children.Methods:The ultrasonographic findings and clinical data of 65 children with SAP that was confirmed by clinical diagnosis or autopsy were retrospectively analyzed.Results:Ultrasonographic manifestations of SAP in children were demonstrated as follows:the pancreases were enlarged to varying degrees,or even to an abnormal shape,with irregular or ill-defined margins;the echo patterns of the pancreas were diverse which included hyperechogenicity,hypoechogenicity or heterogeneous echogenicity;fluid collections in the peripancreatic space and spaces in the abdominal cavity as well as pseudocyst formation were frequently seen;the pancreas of primary SAP presented an abnormal shape and diffuse swelling,with heterogeneous or decreased but no increased echogenicity,and was frequently associated with pseudocyst formation;in secondary SAP,with exception of traumatic SAP,the pancreas had no abnormal shape but showed the presence of localized swelling,with enhanced but no decreased echogenicity,and was not complicated by pseudocyst formation.Among the 65 children,the csuse of SAP was trauma in 28 cases(43.1%),infections in 18 cases(27.6%),idiopathy in 15 cases(23.2%),systemic non-infectious diseases in 3 cases(4.6%),and postoperative stress response in 1 case(1.5%).Conclusion:Ultrasonography can accurately i nd the imaging changes of the pancreas in children with SAP,which can help make an early diagnosis and judgment of its causes,and thereby effectively reduce the mortality in these children.
引文
[1]Lopez MJ.The changing incidence of acute pancreatitis in children:a single-institution perspective[J].J Pediatr,2002,140(5):622-624.
[2]Sánchez-Ramírez CA,Larrosa-Haro A,Flores-Martínez S,et al.Acute and recurrent pancreatitis in children:etiological factors[J].Acta Paediatr,2007,96(4):534-537.
[3]Nydegger A,Heine RG,Ranuh R,et al.Changing incidence of acute pancreatitis:10-year experience at the Royal Children’s Hospital,Melbourne[J].J Gastroenterol Hepatol,2007,22(8):1313-1316.
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[5]黎介寿,李维勤.重症胰腺炎手术指征和时机的再认识[J].中国实用外科杂志,2003,23(9):513-514.
[6]Hardta PD,Mayerb K,Ewald N.Exocrine pancreatic involvement in critically in patients[J].Curr Opin Clin Nutr Metab Care,2009,12(2):168-174.
[7]Manjuck J,Zein J,Carpati C,et al.Clinical significance of increased lipase levels on admission to the ICU[J].Chest,2005,127(1):246-250.
[8]Ferreira M,Coelho R,Luzio J,et al.Increased lipase and amilase levels in critically ill patients:retrospective study[J].Rev Bras Ter Intensiva,2008,20(4):362-369.
[9]李娜,王晓茵.儿童急性胰腺炎与全身炎症反应综合征的关系探讨[J].中国当代儿科学杂志,2008,10(6):715-718.
[10]陈卫坚,祝益民,周峥珍,等.儿童危重症死亡病例胰腺组织损伤临床病理分析[J].临床儿科杂志,2012,30(1):29-32.
[11]中华医学会外科学分会胰腺外科学组.重症急性胰腺炎诊治指南[J].中华外科杂志,2007,45(11):727-729.
[12]蔡庄伟.超声在急性出血坏死型胰腺炎早期诊断中的价值[J].中国超声医学杂志,1998,14(4):54.
[13]姚强.胰腺炎的CT鉴别诊断[J].中国医学创新,2011,8(25):102-103.
[14]祝益民,刘芳,陈卫坚.危重患儿胰腺坏死五例临床分析[J].中国小儿急救医学,2011,18(2):120-122.
[15]Chang YJ,Chao HC,Kong MS,et al.Acute pancreatitis in children[J].Acta Paediatr,2011,100(5):740-744.
[16]陈素贤,王光霞,赵二鹏,等.B超在重型急性胰腺炎中的诊断价值[J].中国中西医结合外科杂志,2009,15(1):37-38.
[17]刘震杰,沈来根.胰腺假性囊肿的治疗现状及进展[J].国际外科学杂志,2006,33(3):189-192.
[18]范欲晓,柏宁野.超声显像在急性胰腺炎诊治中的应用价值[J].中国超声医学杂志,2003,19(11):871-872.
[19]张圣道,雷若庆.我国重症急性胰腺炎治疗的效果和评价[J].外科理论与实践,2001,6(1):10-11.
[20]Yachha SK,Chetri K,Saraswat VA,et al.Management of childhood pancreatic disorders:a multidisciplinary approach[J].J Pediatr Gastroenterol Nutr,2003,36(2):206-212.
[21]黄荣柏,胡锡琮.重症急性胰腺炎手术时机选择的发展与演变[J].中国普通外科杂志,2006,15(6):460-463.
[22]刘芳,杜玉开,祝益民.小儿危重病继发胰腺损害的原因与机制[J].临床儿科杂志,2011,29(7):692-695.
[2]Sánchez-Ramírez CA,Larrosa-Haro A,Flores-Martínez S,et al.Acute and recurrent pancreatitis in children:etiological factors[J].Acta Paediatr,2007,96(4):534-537.
[3]Nydegger A,Heine RG,Ranuh R,et al.Changing incidence of acute pancreatitis:10-year experience at the Royal Children’s Hospital,Melbourne[J].J Gastroenterol Hepatol,2007,22(8):1313-1316.
[4]王志华,王玉水.中西医结合治疗儿童急性胰腺炎的疗效观察[J].中国中西医结合杂志,2009,29(6):556-557.
[5]黎介寿,李维勤.重症胰腺炎手术指征和时机的再认识[J].中国实用外科杂志,2003,23(9):513-514.
[6]Hardta PD,Mayerb K,Ewald N.Exocrine pancreatic involvement in critically in patients[J].Curr Opin Clin Nutr Metab Care,2009,12(2):168-174.
[7]Manjuck J,Zein J,Carpati C,et al.Clinical significance of increased lipase levels on admission to the ICU[J].Chest,2005,127(1):246-250.
[8]Ferreira M,Coelho R,Luzio J,et al.Increased lipase and amilase levels in critically ill patients:retrospective study[J].Rev Bras Ter Intensiva,2008,20(4):362-369.
[9]李娜,王晓茵.儿童急性胰腺炎与全身炎症反应综合征的关系探讨[J].中国当代儿科学杂志,2008,10(6):715-718.
[10]陈卫坚,祝益民,周峥珍,等.儿童危重症死亡病例胰腺组织损伤临床病理分析[J].临床儿科杂志,2012,30(1):29-32.
[11]中华医学会外科学分会胰腺外科学组.重症急性胰腺炎诊治指南[J].中华外科杂志,2007,45(11):727-729.
[12]蔡庄伟.超声在急性出血坏死型胰腺炎早期诊断中的价值[J].中国超声医学杂志,1998,14(4):54.
[13]姚强.胰腺炎的CT鉴别诊断[J].中国医学创新,2011,8(25):102-103.
[14]祝益民,刘芳,陈卫坚.危重患儿胰腺坏死五例临床分析[J].中国小儿急救医学,2011,18(2):120-122.
[15]Chang YJ,Chao HC,Kong MS,et al.Acute pancreatitis in children[J].Acta Paediatr,2011,100(5):740-744.
[16]陈素贤,王光霞,赵二鹏,等.B超在重型急性胰腺炎中的诊断价值[J].中国中西医结合外科杂志,2009,15(1):37-38.
[17]刘震杰,沈来根.胰腺假性囊肿的治疗现状及进展[J].国际外科学杂志,2006,33(3):189-192.
[18]范欲晓,柏宁野.超声显像在急性胰腺炎诊治中的应用价值[J].中国超声医学杂志,2003,19(11):871-872.
[19]张圣道,雷若庆.我国重症急性胰腺炎治疗的效果和评价[J].外科理论与实践,2001,6(1):10-11.
[20]Yachha SK,Chetri K,Saraswat VA,et al.Management of childhood pancreatic disorders:a multidisciplinary approach[J].J Pediatr Gastroenterol Nutr,2003,36(2):206-212.
[21]黄荣柏,胡锡琮.重症急性胰腺炎手术时机选择的发展与演变[J].中国普通外科杂志,2006,15(6):460-463.
[22]刘芳,杜玉开,祝益民.小儿危重病继发胰腺损害的原因与机制[J].临床儿科杂志,2011,29(7):692-695.