儿童慢性胰腺炎的临床表现和诊断
- Authors
- Mohamad Miqdady, MD
Mohamad Miqdady, MD
- Adjunct Faculty
- Cleveland Clinic Foundation
- Seiji Kitagawa, MD
Seiji Kitagawa, MD
- Associate Professor of Pediatric Gastroenterology
- Baylor College of Medicine
- Section Editors
- William J Klish, MD
William J Klish, MD
- Section Editor — Pediatric Gastroenterology
- Emeritus Professor of Pediatrics
- Baylor College of Medicine
- David C Whitcomb, MD, PhD
David C Whitcomb, MD, PhD
- Section Editor — Pancreatic Diseases
- Professor of Medicine
- University of Pittsburgh School of Medicine
- Deputy Editor
- Alison G Hoppin, MD
Alison G Hoppin, MD
- Deputy Editor — Pediatrics
- Assistant Professor of Pediatrics, Part-time
- Harvard Medical School
- Translators
- 谢晓丽, 主任医师
谢晓丽, 主任医师
- 成都市妇女儿童中心医院儿童消化科
引言
慢性胰腺炎是胰腺的进行性炎症性疾病，其特征为胰腺不可逆的结构改变，导致不可逆的胰腺内分泌和/或外分泌功能不全[1-3]。此类结构改变包括：不规则的硬化和弥漫或局灶性的破坏、腺泡细胞减少、胰岛细胞减少、炎症性细胞浸润和胰管异常。胰管堵塞可能是由蛋白栓和/或结石引起。
本文将概述儿童慢性胰腺炎的临床表现、诊断和预后。儿童慢性胰腺炎的具体病因将单独讨论。 (参见“儿童和青少年慢性胰腺炎的病因”)
临床表现
不论何种病因，慢性胰腺炎的临床表现都相似。发病年龄、疾病进展速度，以及预后，取决于具体的病因和基础疾病或病变的严重程度。 (参见“儿童和青少年慢性胰腺炎的病因”)
一些患者表现为反复发作的急性胰腺炎，其他患者可能表现为最初隐匿的腹痛。另一部分患者可能表现为吸收不良或胆总管阻塞引起的梗阻性黄疸[4]。较少情况下，患者可能无症状或仅在发生胰腺功能衰竭征象后表现出症状，这些征象例如吸收不良和糖尿病，胰腺功能衰竭常发生于病程的晚期[1,3,5,6]。这些表现将在下文进行更详细的讨论。
对于存在生长障碍的儿童，尤其是伴有体重不足和营养不良者，其鉴别诊断中应该考虑到慢性胰腺炎。这些儿童的查体通常正常，但可能存在上腹部压痛[3]。如果患者有假性囊肿，则可能触及上腹包块。 (参见“慢性胰腺炎的并发症”)
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