小儿胆道穿孔的诊治经验

Clinical Analysis of Perforation of Bile Duct in Children

目的探讨小儿胆道穿孔的临床特征、诊断、病因及治疗。方法回顾性分析1988年1月～2003年1月我院收治的9例病例资料,评价诊治效果。结果入院后24h内确诊率为88.8%,8例合并有胰胆合流异常,经引流术和Ⅱ期根治术后效果满意。结论胰胆合流异常是小儿胆道穿孔的重要病理基础,腹腔穿刺检查能显著提高自发性胆道穿孔的术前诊断率,胆汁淀粉酶检测有助于胰胆合流异常的诊断,未发现胰胆合流异常的穿孔病例应坚持长期随访。

Objective To evaluate the clinic characteristics of diagnosis ,etiology and treatment of perforation of bile duct in children. Methods Clinical records of 9 children (three boys and 6 girls,age:8～120 months) with perforation of bile duct between Jan 1988 and Jan 2003 in our hospital stay were reviewed. Data including historical features, diagnosis and treatment were analyzed. Results Among all patients,8 cases were diagnosed in the first 24 hours after hospitalization. Eight children complicated with pancreaticobiliary confluence malfunction (PBCM) underwent the total excision of dilated common bile duct and Rouxen-Y hepaticojejunostomy. All of patients were recovered favorably after drainage and the radical operation Ⅱ stage. Conclusions Peritoneocentesis can raise the diagnostic rate of spontaneously perforation of bile duct in children. The diagnosis is also strongly suggested with a high level of total amylase activity in bile. The causes of the localized embryogenic mural malformation of the common bile duct and the PBCM might contribute to the perforation of bile duct in children. Children presented with perforation of bile duct without PBCM indicator must be followed up for long term.