儿童胆囊息肉的诊治分析

Diagnosis and management of gallbladder polyp in children

目的总结儿童胆囊息肉的临床特点和诊治效果, 提高对该疾病的认识。方法收集首都医科大学附属北京儿童医院2010年1月至2020年12月含"胆囊息肉"诊断的27例住院患儿的资料。其中, 男14例, 女13例;平均诊断年龄为12. 2岁, 范围为2. 2~16. 0岁。根据是否行手术治疗分为手术组(3例)与观察组(24例)。手术组患儿于术后3个月内进行门诊复查, 复查内容包括血常规、生化检查和腹部B型超声检查。所有患儿于2021年3月通过电话随访预后, 随访内容包括:有无腹痛、腹胀、腹泻、营养不良以及术后症状是否消失。总结儿童胆囊息肉的临床表现、诊疗及预后, 探讨手术干预的影响因素。结果 3例手术组患儿在术前均存在保守治疗无效的腹胀或腹痛症状, 1例有家族史, 行多次超声检查提示多发息肉(>2枚)或息肉长径≥10 mm, 遂行腹腔镜胆囊切除术, 术后病理诊断结果提示为胆囊息肉合并慢性胆囊炎。患儿术后症状消失, 分别随访3个月、2年10个月和9年6个月, 无相关并发症发生。24例观察组患儿均为其他疾病住院期间完善超声检查时发现胆囊息肉。超声检查结果:息肉单发20例, 平均长径为4. 0 mm, 范围为2. 0~9. 0 mm;息肉多发4例, 均为2枚, 长径<10 mm。观察组中除1例患儿因车祸伤死亡, 余患儿均对胆囊息肉行保守治疗;9例出院后通过超声检查随访, 7例息肉无变化, 2例息肉消失。结论结合家族史对儿童胆囊息肉选择合理的诊治方案。对存在症状且保守治疗无效的患儿行腹腔镜胆囊切除术;对无症状的患儿, 通过超声检查定期随访, 息肉长径≥10 mm时行胆囊切除术。

Objective To explore the clinical features and outcomes of gallbladder polyp(GP)and improve its diagnosis and treatment in children.Methods From January 2010 to December 2020,clinical data were reviewed for 27 hospitalized GP children.There were 14 boys and 13 girls with a mean diagnostic age of 12.2(2.2 to 16.0)years.They were divided into two groups of surgery(n=3)and observation(n=24)according to whether or not surgery was performed.The surgery group received outpatient reexamination within 3 months postoperatively and reexaminations included biochemical tests and abdominal ultrasonography.Follow-ups were conducted by telephone in March 2021,including presence or absence of abdominal pain,abdominal distension,diarrhea,malnutrition and whether or not symptoms disappeared postoperatively.The authors summarized the clinical manifestations,diagnosis,treatment and prognosis of GP and explored the influencing factors of surgical intervention.Results Three children in surgery group had abdominal distension or pain refractory to conservative measures pre-operation.In one child with a family history,multiple ultrasonography revealed multiple polyps(>2)or polyps≥10 mm in long diameter.Laparoscopic cholecystectomy was performed and postoperative pathological examination revealed GP with chronic cholecystitis.The symptoms of 3 children disappeared postoperatively and they were followed up for 3,34 and 114 months respectively without related complications.One child had a family history.Multiple in observation group,GP was detected by ultrasound examination during hospitalization for other diseases.Ultrasonography results:single polyps(n=20)with an average long diameter of 4.0(2.0-9.0)mm;double polyps(n=4)with a long diameter of<10 mm.Except for 1 death due to automobile accident injury,the remainders received conservative measures for GP;among 9 cases with ultrasonic follow-ups after discharge,the outcomes were no change(n=7)and disappearance(n=2).Conclusions In conjunctions with family history,reasonable diagnosis and treatment is selected for GP in children.Laparoscopic cholecystectomy is indicated for symptomatic children not responding to conservative measures.For asymptomatic children,cholecystectomy is performed when long diameter of GP is≥10 mm through regular ultrasonic follow-ups.