儿童胆囊结石的诊治

Diagnosis and treatment of cholecystolithiasis in children

目的探讨儿童胆囊结石的临床特征、治疗方法及预后。方法对鄂尔多斯市中心医院及北京大学第三医院共27例胆囊结石患儿的病例资料进行回顾分析,分析胆囊结石患儿的可能发病相关因素、临床表现、超声及实验室检查、治疗结果。结果27例患儿中,5例患儿发病前有明确的头孢曲松钠用药史,用药时间3~10d。超声结果显示胆囊外形正常者18例,外形增大者9例;囊壁无增厚者17例,囊壁水肿增厚者9例;21例患儿结石为单发,3例患儿结石为多发,结石直径3~21mm,3例患儿结石为沉积物或泥沙样结石。27例患儿中,非手术治疗22例;行腹腔镜胆囊切除术5例,其中1例合并胆总管结石,同期行胆总管探查取石术,患儿均痊愈出院。1例患儿术后即出现胆囊切除术后综合征,主要表现为消化不良、腹泻,持续1年余症状消失。随访截止至2018年10月,5例手术患儿均无结石再发;22例非手术治疗患儿中,10例随访复查超声结石消失,11例患儿随访结石无增大、增多,无右上腹疼痛等相关症状发生,1例患儿结石增大明显,反复出现3次腹痛症状,每次给予保守治疗后均缓解。结论在对腹痛患儿进行诊断时,尤其是患儿肥胖或有头孢曲松钠用药史时,要考虑儿童胆囊结石的诊断可能;儿童胆囊结石行腹腔镜胆囊切除术安全可行;腹痛症状明显且保守治疗不能缓解、合并胆总管结石者可以考虑手术治疗,否则优选非手术治疗。

Objective To explore the clinical features, treatment methods and prognosis of cholecystolithiasis in children.Methods The data of 27 children with cholecystolithiasis in Ordos Central Hospital and Peking University Third Hospital were retrospectively analyzed. The possible pathogenic related factors, clinical manifestations, ultrasonography, laboratory examinations and treatment results of cholecystolithiasis in children were analyzed. Results Among the 27 cases, 5 cases had definite history of ceftriaxone sodium medication, medication time was 3-10 d. Ultrasound results showed that the shape of gallbladder was normal in 18 cases and enlarged in 9 cases;17 cases had no cystic wall thickening, and 9 cases had cystic wall edema and thickening;21 cases had single stone, 3 cases had multiple stones, and the diameter of stones ranged from 3 to 21 mm, 3 children had sedimentary or sediment-like calculi. Among the 27 cases, 22 cases were treated by non-surgical treatment and 5 cases were treated by laparoscopic cholecystectomy, one of them with common bile duct stone and received laparoscopic common bile duct exploration. All of them cured and discharged from hospital. Postoperative cholecystectomy syndrome occurred in one case, mainly manifested as dyspepsia and diarrhea, which lasted for more than 1 year and disappeared. Followed-up until October 2018, there was no recurrence of calculi in 5 children with surgery;among 22 cases of non-surgical treatment, 10 cases of follow-up ultrasound showed that the stones disappeared, 11 cases of follow-up found that the stones did not increase, enlarge, no right upper abdominal pain and other related symptoms occurred, 1 case of children with stones enlarged significantly, repeated three times of abdominal pain symptoms, which alleviated after each conservative treatment. Conclusion In the diagnosis of children with abdominal pain, especially obesity children or children with history of ceftriaxone sodium medication, the possibility of diagnosis of cholecystolithiasis in children should be considerd;laparoscopic cholecystectomy in cholecystolithiasis children is safe and feasible;children with obvious abdominal pain symptoms which were unremitting under conservative treatment, combined with choledocholithiasis can consider surgical treatment, otherwise non-surgical treatment is preferred.