小儿胆石症的诊断与治疗

Diagnosis and treatment of cholelithiasis in children

目的探讨小儿胆石症的病因、诊断及治疗方法。方法分析22例小儿胆石症的临床资料,20例行手术治疗,2例行非手术治疗。14例行胆囊切除术(其中8例行腹腔镜胆囊切除术),3例行胆总管切开取石、T管引流术,2例行胆囊切除、胆总管探查、T管引流术,1例行胆总管囊肿切除、肝总管空肠Roux-en-Y吻合术。结果18例经手术治疗后症状消失,术后1例出现胆瘘,经引流后痊愈,1例右肝管内结石残留。18例(81.8%)得到随访,4例失访。随访5个月至7年,患儿生长发育正常,3例偶有腹痛、腹胀,1例行二次胆总管切开取石术,术后恢复顺利。行非手术治疗的2例病人经保守治疗后近期症状缓解,其中1例症状反复发作。结论对有腹痛者首选B超检查,对有胆总管扩张或黄疸的患儿结合CT检查可提高正确诊断率;症状明显的胆石症应早期手术治疗;腹腔镜可作为胆囊切除的首选治疗方法。

Objective To evaluate the etiology, diagnosis and treatment of cholelithiasis in children. Methods The clinical data of 22 children with cholelithiasis were retrospectively analysed. Twenty patients underwent operative treatments, 14 had cholecystectomy （including 8 patients with successful laparoscopic cholecystectomy） ; 3 with common bile duct exploration and T-tube drainage; 2 with cholecystectomy, bile duct exploration and T-tube drainage; and 1 with excision of choledochal cyst and Roux-en-Y hepaticojejunostomy. Results Eighteen patients complelely recovered after operation. At follow-up of 5 months to 7 years in 1 8 cases （ 81. 8 % ） , all children grew up well, but 3 cases had occasional abdominal pain and distention, of which one recovered after choledochotomy and stone removal, and 1 was relieved with conservative therapy, but 1 still had recurrent symptoms. Conclusions Children with abdominal pain should first be examined by B -ultrasound. In cases with dilatation of common bile duct, additional CT exam can improve the accuracy of diagnosis. Children with evident symptoms of cholelithiasis should have early operative treatment. Laparoscopic cholecystectomy is the method of choice for gallbladder stones in children.