Endoscopic retrograde cholangiopancreatography in diagnosis and treatment of pediatric pancreaticobiliary maljunction：a report of 74 cases

doi:10.16139/j.1007-9610.2020.06.005

Abstract

Abstract:

Objective To investigate the safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of pediatric pancreaticobiliary maljunction(PBM). Methods A total of 74 children with PBM diagnosed by ERCP were enrolled. The clinical data with postoperative follow-up were analyzed. Results There were 32 cases with type A, 16 cases with type B, 23 cases with type C and 3 cases with type D based on the classification of PBM proposed by Japanese Study Group on PBM. The positive diagnostic rate of PBM was only 8% using MRCP. All children underwent endoscopic sphincteropapillotomy with endoscopic nasobiliary drain of which 69 cases(93.4%) were preceded with extraction of pancreatic protease emboli or stones. Pancreatic stent was followed in 2 cases. Seven cases (9.5%) had mild pancreatits after ERCP. No bleeding or cardiac laceration and perforations were found. The children had resection of extrahepatic bile duct combined with hepatic duct jejunum Roux-en-Y anastomotisis except for 7(9.5%) cases without biliary dilatation. Conclusions ERCP could be performed safely with effective diagnosis and treatment in pediatric PBM, and is an important procedure for children with PBM during early stage.

Key words: Pancreaticobiliary maljunction, Endoscopic retrograde cholangiopancreatography, Pediatric, Congenital common bile duct dilatation

CLC Number:

WENG Mingzhe, WENG Hao, TAO Yijing, GU Jun, ZHANG Wenjie, WANG Xuefeng. Endoscopic retrograde cholangiopancreatography in diagnosis and treatment of pediatric pancreaticobiliary maljunction：a report of 74 cases[J]. Journal of Surgery Concepts & Practice, 2020, 25(06): 468-472.

Figures/Tables 3

References 20

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一般情况	例数（n=74）
男	23(29.4)
年龄（岁）	3.9±2.6
Komi分型
B-P型	35（47.3）
P-B型	16（21.6）
复杂型	3（4.1）
未明确分型	20（27.0）
JSGPM分型
A型	32（43.2）
B型	16（21.6）
C型	23（31.1）
D型	3（4.1）
伴随症状
腹痛	70（94.6）
黄疸	31（41.9）
发热	45（60.8）
呕吐	56（75.7）
入院诊断
急性胰腺炎	4（5.4）
胆道感染	60（81.1）
梗阻性黄疸	31（41.9）
先天性胆道扩张	63（85.1）
术前影像学检查阳性	6（8.1）

JSGPM分型	A型（n=32）	B型（n=16）	C型（n=23）	D型（n=3）	P值
男	11(34.4)	5(31.3)	7(30.4)	0	0.73
年龄（岁）	1.5±0.6	4.2±1.5	3.5±2.1	4.8±3.6	<0.05
胆总管扩张
有	32(100)	9(56.2)	22(95.6)	3（100）	<0.05
无	0	7(43.8)	1(4.4)	0	<0.05
胆总管最大径（mm）	28.5±10.4	8.5±4.1	19.2±7.9	11.5±4.5	<0.05
共同通道长度（mm）	8.5±4.8	10.8±4.2	12.6±3.9	12.8±3.7	>0.05
蛋白酶栓	28（87.5）	13（81.3）	23(100)	3（100）	>0.05
胆总管结石	5(15.6)	1(6.3)	2(8.7)	0	<0.05
ERCP干预
乳头肌切开	32(100)	16(100)	23(100)	3(100)	>0.05
取石	29(90.6)	14（87.5）	23(100)	3(100)	>0.05
胰管支架	0	0	0	3(100)	<0.05
EMBD	32(100)	16(100)	23(100)	3(100)	>0.05
胆汁淀粉酶	81 531±53 122	79 531±58 149	89 413±52 145	74 112±33 123	>0.05
肝外胆管切除+ 肝管空肠Roux-en-Y吻合	32(100)	9(56.2)	23(100)	3(100)	<0.05