Детская хирургия. Журнал им. Ю.Ф. Исакова. 2021; 25: 368-374
Эндосонография панкреатобилиарной области у детей. Первый опыт
https://doi.org/10.55308/1560-9510-2021-25-6-368-374Аннотация
Введение. Диагностика пороков развития и заболеваний органов панкреатобилиарной области у детей является актуальной проблемой. Увеличение числа пациентов детского возраста с панкреатобилиарными аномалиями, осложнениями желчнокаменной болезни, острым и хроническим панкреатитом требует внедрения новых методов неинвазивной диагностики, что позволит выбрать оптимальную тактику лечения.
Материал и методы. В статье представлен опыт проведения эндосонографии 44 детям в возрасте от 2 до 17 лет, в течение 2,5 лет. Показаниями для проведения эндосонографии явились: осложнённое течение желчнокаменной болезни, кисты холедоха, расширение панкреатических протоков, вирсунголитиаз, кистозные и солидные образования поджелудочной железы и сальниковой сумки. Лечебно-диагностические пункции под контролем эндосонографии выполнены у 10 пациентов, трансгастральное дренирование панкреатических псевдокист – у 6 детей.
Результаты. Во всех наблюдениях эндосонография оказалась информативным методом диагностики. Полученные в ходе эндосонографии данные позволили изменить тактику лечения у 21 (47,7%) больного; уточнить анатомо-топографические особенности со стороны органов панкреатобилиарной зоны – у 15 (34,1%), определить оптимальный объём оперативного вмешательства – у 6 (13,6%) больных. Осложнений во время диагностических процедур не было. При трансгастральном дренировании в одном наблюдении отмечено кровотечение в просвет псевдокисты.
Заключение. Эндосонография у детей является информативным неинвазивным методом диагностики пороков развития и заболеваний панкреатобилиарной области, позволяющим получить окончательные данные о строении желчных и панкреатических протоков, локализации и характере очаговых поражений поджелудочной железы, а также уточнить показания к различным интервенционным вмешательствам.
Список литературы
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25. Ramesh J., Bang J.Y., Trevino J., Varadarajulu S. Endoscopic ultrasound-guided drainage of pancreatic fluid collections in children. J Pediatr Gastroenterol Nutr. 2013; 56: 30–5.
Russian Journal of Pediatric Surgery. 2021; 25: 368-374
Endosonography of the pancreatobiliary area in pediatric patients. The first experience
https://doi.org/10.55308/1560-9510-2021-25-6-368-374Abstract
Introduction. The diagnostics of malformations and diseases in the organs of pancreatobiliary area in children is an actual problem. An increase in the number of pediatric patients with pancreatobiliary anomalies, complications of cholelithiasis, acute and chronic pancreatitis requires the development of new techniques of non-invasive diagnostics which would allow to choose the optimal curative tactics.
Material and methods. The article presents authors' experience of performing endosonography in 44 children, aged 2–17, during 2.5 years. Indications for endosonography were: complicated cholelithiasis, choledochal cyst, pancreatic duct dilatation, lithiasis of the Wirsung’s duct, cystic and solid formations in the pancreas and omental sac. Fine-needle aspirations under endosonography control were performed in 10 patients; transgastric drainage of pancreatic pseudocysts - in 6 children.
Results. In all cases, endosonography turned out to be an informative diagnostic option. The curative tactics was changed in 21 (47.7%) patients after receiving endosonographic findings. Besides, such findings clarified anatomical and topographic features of organs in the pancreatobiliary zone in 15 (34.1%) patients; endosonographic findings helped to define the optimal volume of surgical intervention in 6 (13.6%) patients. There were no complications during diagnostic procedures. Bleeding into the lumen of pseudocyst was noted in a patient with transgastric drainage.
Conclusion. Endosonography in children is an informative non-invasive technique for diagnosing malformations and diseases of the pancreatobiliary region because it allows to obtain the final picture of biliary and pancreatic ducts, of the site and nature of focal lesions in the pancreas, as well as to clarify indications for various interventions.
References
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2. Thomson M., Tringali A., Dumonceau J.M., at al. Paediatric gastrointestinal endoscopy: European society for paediatric gastroenterology hepatology and nutrition and European society of gastrointestinal endoscopy guidelines. J Pediatr Gastroenterol Nutr. 2017; 64(1): 133–53.
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4. Sharma M., Wani Z.A., Bansal R., Hari S.R. Utility of narrow caliber echobronchoscope in preschool pediatric population: a case series (with video). Endosc Ultrasound. 2013; 2: 96–101.
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9. Jia Y., Maspons A., Othman M.O. The Therapeutic Use of Endoscopic Ultrasonography in Pediatric Patients is Safe: A Case Series. The Saudi Journal of Gastroenterology. 2018; 21(6): 391–5.
10. Jazrawi S.F., Barth B.A. Efficacy of Endoscopic Ultrasound-Guided Drainage of Pancreatic Pseudocysts in a Pediatric Population. Dig Dis Sci. 2011; 56: 902–8.
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13. Al-Rashdan A., LeBlanc J., Sherman S., at al. Role of endoscopic ultrasound for evaluating gastrointestinal tract disorders in pediatrics: a tertiary care center experience. J Pediatr Gastroenterol Nutr. 2010; 51: 718–22.
14. Attila T., Adler D.G., Hilden K., Faigel D.O. EUS in pediatric patients. Gastrointest Endosc. 2009; 70: 892–8.
15. Cohen S., Kalinin M., Yaron A., at al. Endoscopic ultrasonography in pediatric patients with gastrointestinal disorders. J Pediatr Gastroenterol Nutr. 2008; 46: 551–4.
16. Fishman D.S., Chumpitazi B.P., Raijman I., at al. Endoscopic retrograde cholangiography for pediatric choledocholithiasis: Assessing the need for endoscopic intervention. World J Gastrointest Endosc. 2016; 8(11): 425–32.
17. Patel S., Marshak J., Daum F, Iqbal S. The emerging role of endoscopic ultrasound for pancreaticobiliary diseases in the pediatric population. World J Pediatr. 2017; 13(4): 300–6.
18. Abu-El-Haija M., Nathan J.D. Pediatric chronic pancreatitis: Updates in the 21st century. Pancreatology. 2018; 18(4): 354–9.
19. Scheers I., Ergun M., Aouattah T, et al. Diagnostic and therapeutic roles of endoscopic ultrasound in pediatric pancreaticobiliary disorders. J Pediatr Gastroenterol Nutr. 2015; 61: 238–47.
20. Fujishiro J., Masumoto K., Urita Y., Shinkai T, Gotoh C. Pancreatic complications in pediatric choledochal cysts. J Pediatr Surg. 2013 Sep; 48(9): 1897–902.
21. Párniczky A., Czakó L., Dubravcsik Z, et al. Pediatric pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group. Orv Hetil. 2015; 156(8): 308–25.
22. Sharma S.S., Maharshi S. Endoscopic management of pancreatic pseudocyst in children-a long-term follow-up. J Pediatr Surg. 2008; 43(9): 1636–9.
23. Breckon V., Thomson S.R., Hadley G.P. Internal drainage of pancreatic pseudocysts in children using an endoscopically placed stent. Pediatr Surg Int. 2001; 17: 621–3.
24. Starkov Yu.G., Solodinina E.N., Shishin K.V. Endosonografiya – novye diagnosticheskie vozmozhnosti v khirurgicheskoi klinike. Endoskopicheskaya khirurgiya. 2006; 12(2): 126–7.
25. Ramesh J., Bang J.Y., Trevino J., Varadarajulu S. Endoscopic ultrasound-guided drainage of pancreatic fluid collections in children. J Pediatr Gastroenterol Nutr. 2013; 56: 30–5.
