儿童自发性胆道穿孔的诊治

Diagnosis and treatment of spontaneous perforation of the bile duct in children

目的:探讨儿童自发性胆道穿孔的病因、临床特点、诊断及治疗。方法:回顾分析我院1998～2006年收治的8例儿童自发性胆道穿孔病例资料。结果:8例病例中5例术前得以确诊,手术方式采用T管引流及腹腔引流,效果满意。3例合并有胆总管囊肿的患儿行二期根治术后治愈。结论:儿童自发性胆道穿孔病因尚不明确,胰胆管合流异常可能是主要原因,腹腔穿刺对本病的诊断有重要价值,手术方式采用T管引流及腹腔引流,合并有胰胆管合流异常的患儿需行二期根治术,未发现胰胆管合流异常的穿孔病例应陔长期随访。

Objective：TO evaluate the etiology,clinic characteristics,diagnosis and treatments of spontaneous perforation of the bile duct in children. Methods：The clinical data of eight children with spontaneous perforation of the bile duct between 1998 -2006 were analyzed retrospectively. Results：5 of 8 cases were diagnosed bile duct perforativn before operation,all the patients recovered favorably after T-tube and pelvic drainage. 3 children complicated with choledochal cyst were cured after Ⅱ stage radical operation. Conclusions：the etiology of spontaneous perforation of the bile duct in children is unclear, pancreaticobiliary confluence malfunction （PBCM） maybe the main reason. Peritoneocentesis is very important to the diagnosis, which is diffcult in child preoperatively. The effective surgical treatments are T-tube and pelvic drainage. The children complicated with PBCM need Ⅱ stage radical operation,and long term follow up are necessary for the children present with spontaneous perforation of the bile duct without PBCM.