儿童胆道穿孔的临床分析及病因探讨

Clinical analysis and etiology of biliary perforation in children

目的探讨儿童胆道穿孔的病因、临床特点及早期诊断要点。方法对我院2015年1月～2018年10月收治的27例经手术证实为胆道穿孔患儿临床资料进行回顾性分析。结果胆道穿孔患儿27例,男性8例,女性19例,平均年龄2岁5月(2.39岁),主要临床表现:呕吐21例(77.78%)、发热、腹痛15例(55.56%)、腹胀12例(44.44%)、黄疸8例(29.63%)、腹膜刺激征阳性17例(62.96%)。腹部超声检查提示:有20例合并胆道扩张(其中胆总管囊样扩张14例),12例合并胆囊壁增厚。术中发现穿孔部位在胆总管18例,肝总管4例,右肝管1例,胆囊管1例,未发现穿孔部位3例。结论胰胆合流异常是儿童自发性胆道穿孔的重要病理基础。儿童胆道穿孔可通过临床表现、腹部超声、腹腔穿刺术早期确诊,一旦确诊,需尽早手术。

Objective To investigate the etiology, clinical features and early diagnosis of biliary perforation in children.Methods A retrospective analysis was conducted on clinical data of children with biliary tract perforation admitted to our hospital from January 2015 to October 2018.Results 27 children with biliary perforation were involved, 8 males and 19 females with an average age of 2.39 years old. The main clinical presentations were vomiting(77.78%),fever and abdominal pain(55.56%),abdominal distension(44.44%), jaundice(29.63%),and 17 cases with positive peritoneal irritation(62.96%).Imaging examination showed that there were 20 cases with biliary dilatation(including 14 cases of cystic dilatation of the common bile duct),and 12 cases with thickening of the gallbladder wall.During the operation,the perforation sites were found in common bile duct(18),common hepatic duct(4),right hepatic duct(1),cystic duct(1),and perforation(3).Conclusion Abnormal pancreaticobiliary con?uence is an important pathological basis for spontaneous biliary perforation in children. Biliary perforation can be diagnosed early by clinical manifestations, abdominal ultrasound or CT, and abdominal puncture. Once diagnosed, surgery should be performed as soon as possible.