Детская хирургия. Журнал им. Ю.Ф. Исакова. 2022; 26: 314-320
Эндоскопические вмешательства при пороках развития и заболеваниях поджелудочной железы у детей
https://doi.org/10.55308/1560-9510-2022-26-6-314-320Аннотация
Введение. Пороки развития и заболевания поджелудочной железы (ПЖ) сложны и сопряжены с риском развития осложнений. Внедрение интервенционной эндоскопии – одно из направлений, позволяющих решить данную проблему.
Материал и методы. В исследование включены 24 пациента в возрасте от 3 до 17 лет, которым выполнено 36 интервенционных эндоскопических вмешательств.
Результаты. Транспапиллярные вмешательства выполнены 10 детям, у всех выявлены аномалии протоковой системы ПЖ. Стеноз дистальных отделов панкреатических протоков выявлен у 3 больных, которым выполнено стентирование Вирсунгова протока. Вирсунголитиаз подтверждён в 3 наблюдениях, из них аномалия протоков в виде неполной расщеплённой железы выявлена у 2 пациентов. Разделённая ПЖ выявлена у 1 больного, что потребовало сфинктеротомии малого дуоденального сосочка. Трансмуральные вмешательства выполнены в 13 наблюдениях: пункция у 7 пациентов с интра- или парапанкреатическими кистозными образованиями, дренирование у 6 – с панкреатическими псевдокистами. Комбинированное лечение (транспапиллярное и трансмуральное вмешательства) выполнено одному ребёнку с травматическим разрывом ПЖ.
Обсуждение. Этиология панкреатита у детей связана с аномалиями развития и генетическими факторами. Ведущим патогенетическим фактором развития осложнений является гипертензия в протоках ПЖ. Традиционные оперативные вмешательства при панкреатите часто травматичны и сопровождаются высоким риском осложнений. Внедрение менее инвазивных методик, таких как интервенционная эндоскопия, позволяет решить проблему при некоторых заболеваниях ПЖ.
Заключение. Транспапиллярные вмешательства могут эффективно устранить гипертензию в протоках ПЖ при их дилатации и вирсунголитиазе. Трансмуральные вмешательства могут применяться для уточнения этиологии кистозных образований ПЖ, а также для дренирования панкреатических псевдокист.
Список литературы
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Russian Journal of Pediatric Surgery. 2022; 26: 314-320
Endoscopic interventions for pancreas malformations and diseases in children
https://doi.org/10.55308/1560-9510-2022-26-6-314-320Abstract
Introduction. Malformations and diseases of the pancreas are associated with the risk of complications. Interventional endoscopy is one of the ways to solve this problem.
Material and methods. 24 patients (3–17 y.o.) were included in the study. 36 interventional endoscopic interventions were performed.
Results. Transpapillary interventions were performed in 10 patients, all of them had anomalies of the ductal system. Stenosis of the distal pancreatic ducts was detected in 3 cases, in which stenting of the Wirsung duct was performed. Virsungolithiasis was confirmed in 3 cases, in which an anomaly of the ducts in the form of an incomplete split gland was detected in 2 patients. Pancreas divisum was detected in 1 patient, which required sphincterotomy of the minor duodenal papilla. Transmural interventions were performed in 13 cases: puncture – in 7 patients with intra- or parapancreatic cystic formations; drainage – in 6 patients with pancreatic pseudocysts. One child with traumatic rupture of the pancreas had a combined intervention (transpapillary and transmural).
Discussion. The etiology of pancreatitis in children is associated with developmental anomalies and genetic factors. The leading pathogenetic factor in the development of complications is hypertension in the ducts of the gland. Traditional surgical interventions for pancreatitis are often traumatic and are accompanied by a high risk of complications. The introduction of minimally invasive techniques, such as interventional endoscopy, can solve the problem in some diseases of the pancreas.
Conclusion. Transpapillary interventions can effectively eliminate hypertension in the pancreatic ducts in case of their dilatation and virsungolithiasis. Transmural interventions can be used to clarify the etiology of pancreatic cysts, as well as to drain pancreatic pseudocysts.
References
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