Acute Pancreatitis in Children: 10-year Experience in a Medical Center

兒童急性胰臟炎：一醫學中心十年之經驗

陳秋芬(Chiu-Fen Chen) ； 江文山(Man-Shan Kong) ； 賴明瑋(Ming-Wei Lai) ； 王超然(Chao-Jan Wang)

《Acta Paediatrica Taiwanica》 47卷4期 (2006/08) Pp. 192-196

https://doi.org/10.7097/APT.200608.0192

摘要

背景：本研究的目的是探討兒童急性胰臟炎的導因、臨床表現、影像檢查結果及預後。
方法：我們收集自1992年至2002年十年期間，因急性胰臟炎住院的病人之病歷作分析。急性胰臟炎的診斷包括：相關臨床症狀，血清胰臟超過正常值上限的3倍以上，及影像檢查的異常。
結果：總共有75 位病人，96次急性胰臟炎。其中36位為男性，39位為女性，平均年齡10歲。最常見的導因依次為：不明原因(26.7%)，系統性疾病(22.7%)，膽道疾病(21.3%)，外傷(16%)等。臨床症狀以腹痛(93.8%)，嘔吐(64.2%)，發燒(33.3%)為主。超音波及電腦斷層攝影用於診斷胰臟炎的敏感度分別為57.3%及74.4%。同時，腹部超音波成功檢查出所有患有膽道疾病及併發假性囊腫的病人。在所有病人中，有6位產生假性囊腫，16位罹患反覆性胰臟炎。併發假性囊腫的6 位病患中，有4位是外傷引起的。而本身有高血脂症或膽道疾患者， 則較易有再次發作的情形。有55位病人(73.3%)只需保守治療即可康復，其他20位(26.7%)還必須接受手術或其他侵入性治療。有4位病人死亡，死亡率為5.3%，其中的3位(75%)本身患有其他系統性疾病。
結論：兒童急性胰臟炎的原因是多樣化的。在診斷方面，電腦斷層攝影較超音波檢查擁有較高的敏感度；就併發症而言，假性囊腫較常發生於外傷性胰臟炎的病人，而患有高血脂症的病人，則較容易有反覆性胰臟炎發作。兒童急性胰臟炎的預後佳，死亡率低，大部分死亡的病人本身患有其他疾病。

關鍵字

胰臟炎 ； 兒童 ； 預後

並列摘要

Background: Acute pancreatitis is uncommon in children compared with adults. The purpose of this study was to evaluate the etiologies, clinical presentations, image findings and outcome of children's acute pancreatitis.
Methods: The medical records of children and adolescent patients admitted due to pancreatitis from July 1992 to July 2002 were reviewed. The diagnosis of pancreatitis was based on clinical symptoms, at least threefold elevation of serum pancreatic enzymes, and image findings.
Results: This study comprised 75 patients with 96 episodes of pancreatitis. There were 36 males and 39 females, with a mean age of 10 years. The leading etiologies were idiopathic (26.7%), systemic diseases (22.7%), biliary tract disease (21.3%), and trauma (16%). Common initial manifestations included abdominal pain (93.8%), vomiting (64.2%), and fever (33.3%). The sensitivities of ultrasonography (US) and computed tomography (CT) in detecting pancreatitis were 57.3% and 74.4%, respectively. The morbidity included 6 pseudocysts and 16 repeated pancreatitis. Four pseudocysts were resulted from traumatic pancreatitis. Patients with hyperlipidemia and biliary tract disorder were more likely to have repeated attacks. Fifty-five (73.3%) patients recovered after conservative management, the remaining 20 (26.7%) patients needed surgical or other interventional treatment. The mortality rate was 5.3%. Three fatal cases (75%) had
underlying medical diseases.
Conclusions: The etiologies of acute pancreatitis are diverse. Abdominal CT is more sensitive than US in the diagnosis of pancreatitis. Pseudocysts are more likely to occur in patients with traumatic pancreatitis. Patients with hyperlipidemia are prone to recurrent pancreatitis. The prognosis of children's pancreatitis is good. Most patients with fatal outcome had coexistent medical diseases.

並列關鍵字

pancreatitis ； children ； outcome