探讨内镜下逆行胰胆管造影术(ERCP)对儿童胆胰疾病诊治的有效性和安全性。

选择2014年5月至2025年4月被诊断为胆胰疾病于四川大学华西医院接受ERCP诊治的128例患儿为研究对象。其中，男性患儿为59例，女性为69例，根据年龄不同将其分为幼儿期组(n＝12，1~3岁)，学龄前期组(n＝24，4~6岁)，学龄期组(n＝54，7~12岁)和青春期组(n＝38，13~14岁)。采用回顾性分析方法，对不同年龄组患儿ERCP术前被拟诊疾病类型构成、ERCP适应证、操作成功率、诊治情况及术后并发症发生情况进行分析。本研究遵循的程序符合四川大学华西医院生物医学伦理委员会规定，通过该伦理委员会审批[审批文号：2025年审(1621)号]，患儿法定监护人或授权委托人均与本研究签署ERCP手术知情同意书。

①这128例患儿中，术前被拟诊为胆道疾病者为70例，胰腺疾病者为58例。对128例患儿共计进行154例次ERCP操作，操作成功为132例次，操作成功率为85.7%(132/154)；其中治疗性ERCP为129例次(97.7%, 129/132)。对学龄前期组患儿的ERCP操作成功率最高(96.4%，27/28)。②对这128例患儿进行ERCP治疗的主要适应证为胆管结石(36.7%，47/128)、慢性胰腺炎(21.1%，27/128)和胰胆管梗阻所致急性胰腺炎(19.5%，25/128)。对术前被拟诊为胆道疾病的70例患儿，共计进行80例次ERCP操作，胆管插管成功率为95.0%(76/80)，ERCP操作成功率为91.3%(73/80)；对术前被拟诊为胰腺疾病的58例患儿，共计进行74例次ERCP操作，胰管插管成功率为94.6%(70/74)，ERCP操作成功率为79.7%(59/74)。此外，部分患儿经ERCP明确诊断为先天性胆胰管结构异常，包括先天性胆总管囊肿(CCC)为7例、胰胆管合流异常(PBM)为9例及胰腺分裂症(PD)为2例。患儿经ERCP治疗后，胆管结石及胰管结石患儿的结石均得以清除，胆胰管梗阻均得到解除，相关临床症状亦均明显改善。③这128例患儿的154例次ERCP术后并发症发生率为6.5%(10/154)；其中ERCP术后胰腺炎(PEP)发生率为5.2%(8/154)，胆道感染和支架脱落发生率均为0.6%(1/154)；但是无一例患儿发生术后出血、穿孔及死亡等严重并发症。

ERCP在儿童胆胰疾病诊断与治疗中，均具有较好的有效性和安全性，可作为儿童胆胰疾病的重要微创诊治手段。

To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients with pancreaticobiliary diseases.

From May 2014 to April 2025, a total of 128 children with pancreatobiliary diseases who underwent ERCP at West China Hospital, Sichuan University, were retrospectively enrolled into this study. Among them, 59 were boys and 69 were girls. According to age, the patients were divided into four groups: toddler group (n=12, 1-3 years old), preschool group (n=24, 4-6 years old), school-age group (n=54, 7-12 years old), and adolescent group (n=38, 13-14 years old). The preoperative disease spectrum, indications for ERCP, procedural success rate, diagnostic and therapeutic outcomes, and postoperative complications were retrospectively analyzed among different age groups. This study was approved by the Biomedical Ethics Committee of West China Hospital, Sichuan University [Approval No. 2025 Review (1621)]. Written informed consent for ERCP was obtained from the legal guardians or authorized representatives of all children.

①Among the 128 children, 70 were preoperatively diagnosed with biliary diseases and 58 with pancreatic diseases. A total of 154 ERCP procedures were performed, of which 132 were successful, with an overall procedural success rate of 85.7% (132/154). Among the successful procedures, 129 were therapeutic ERCP, accounting for 97.7% (129/132). The preschool group had the highest procedural success rate (96.4%, 27/28). ② The main indications for ERCP were bile duct stones (36.7%, 47/128), chronic pancreatitis (21.1%, 27/128), and acute pancreatitis caused by pancreaticobiliary duct obstruction (19.5%, 25/128). Among the 70 children preoperatively diagnosed with biliary diseases, 80 ERCP procedures were performed, with a biliary cannulation success rate of 95.0% (76/80) and a procedural success rate of 91.3% (73/80). Among the 58 children preoperatively diagnosed with pancreatic diseases, 74 ERCP procedures were performed, with a pancreatic duct cannulation success rate of 94.6% (70/74) and a procedural success rate of 79.7% (59/74). In addition, congenital pancreaticobiliary duct anomalies were confirmed by ERCP in some children, including congenital choledochal cysts in 7 cases, pancreaticobiliary maljunction in 9 cases, and pancreas divisum in 2 cases. After ERCP treatment, bile duct stones and pancreatic duct stones were successfully removed, pancreaticobiliary duct obstruction was relieved, and related clinical symptoms were alleviated. Among the 154 ERCP procedures, postoperative complications occurred in 10 procedures, with an overall complication rate of 6.5% (10/154). Post-ERCP pancreatitis (PEP) was the most common complication, occurring in 8 procedures, with an incidence of 5.2% (8/154). Biliary tract infection and stent dislodgement each occurred in 1 procedure, with an incidence of 0.6% (1/154). No bleeding, perforation, or procedure-related mortality was observed.

ERCP showed favorable efficacy and safety in the diagnosis and treatment of pediatric pancreatobiliary diseases and may serve as an important minimally invasive diagnostic and therapeutic approach for these diseases in children.