小児急性膵炎。臨床プロファイルとコレクションの自然史

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Pancreatology.2020 Jun;20(4):659-664. S1424-3903(20)30098-3. doi: 10.1016/j.pan.2020.03.007.Epub 2020-03-13.

小児急性膵炎。臨床プロファイルとコレクションの自然史

Paediatric acute pancreatitis: Clinical profile and natural history of collections.

Sadhna B Lal
Vybhav Venkatesh
Surinder S Rana
Neha Anushree
Anmol Bhatia
Akshay Saxena

PMID: 32205063 DOI: 10.1016/j.pan.2020.03.007.

抄録

BACKGROUND & AIMS: Acute Pancreatitis (AP) tends to have a benign course in children. However there is a paucity of information with respect to severity of AP in children, the categorization of collections viz., walled off necrosis (WON)& pseudocyst and their natural history & outcomes.

方法:

当センターで膵炎と診断され管理されている187名の小児の医療記録をレトロスペクティブにレビューした。

METHODS: A retrospective medical record review of 187 children with pancreatitis diagnosed and managed at our centre was performed.

結果:

RESULTS: 101 children (59% boys, Median age 9yrs) had AP of which 37.6%, 60.4% and 2% had mild, moderately severe and severe AP. 61.4%(62) had PFC at diagnosis; 34%(21) acute pancreatic fluid collections (APFC) and 66%(41) acute necrotic collections (ANC). 52.3%(11of21) of APFC evolved into pseudocysts & 68.2%(28of41) of ANC into WON's. Drainage was required in 31%(12of39) of persisting collections, more frequently in children with traumatic AP. Percutaneous catheter drainage (PCD) was done in 6 children and endoscopic ultrasound (EUS) guided cystogastrostomy with placement of plastic or self expanding metal stents (SEMS) in 6 children.

結論:

中等度の重症APは入院中の小児に多く、PFCの発生は61.4％で、その大部分はAPFCである。APFCの48％とANCの32％は消失し、残りは仮性嚢胞またはWONに進展する。非外傷性APの小児では、WONよりも仮性嚢胞を持つ小児の方が自然治癒する可能性が高い。

CONCLUSIONS: Moderately severe AP is common in hospitalized children with AP with PFC developing in 61.4%, majority being APFC. 48% of APFC and 32% of ANC will resolve and the rest evolve into pseudocyst or WON. Spontaneous resolution is more likely in children with non -traumatic AP having pseudocysts rather than WON's.