小儿胆石症诊断与治疗体会_医学论文.docVIP

小儿胆石症诊断与治疗体会_医学论文 小儿胆石症诊断与治疗体会_医学论文 【摘要】 目的 探讨小儿胆石症的诊断与治疗方法。方法 回顾性总结19年间小儿胆石症25例的临床资料。男19例，女6例；年龄5个月～17岁（平均年龄9.5岁）。胆囊结石13例，胆总管结石9例，肝内胆管结石3例。合并急、慢性胆囊炎17例，其中胆囊积液、积脓5例；急性梗阻性化脓性胆管炎3例。除3例（胆囊结石1例和肝内胆管结石2例）经保守治疗症状缓解拒绝手术外，均行手术治疗。手术方式：胆囊切除10例，胆囊切开取石术2例；胆囊切除、胆总管切开取石术7例，单纯胆总管切开取石2例；肝管切开及肝左外叶切除1例。结果 本组22例手术治愈出院，无并发症发生。17例（77.3%）随访1～10年，生长发育良好，仅1例偶有上腹部疼痛。B超检查未发现有残余结石及复发性结石者。结论 小儿胆石症缺乏典型症状，对有腹痛和（或）黄疸者首选B超检查，结合腹部X线平片可提高诊断率；诊断确定应行手术治疗，胆囊切除是治疗胆囊结石较好术式，胆总管切开应严格掌握指征。 【关键词】 胆石症；儿童；诊断；治疗；胆囊切除术 【Abstract】 Objective To investigate the diagnosis and treatment of cholelithiasis in childhood.Methods The clinical data of 25 cases of cholelithiasis in childhood over a 19-year period were reviewed.19 cases were male and 6 cases female.The age ranged from 5 months to 17 years old(the average age is 9.6 years).There were 13 cases of cholecystolithiasis and 9 cases of choledocholethiasis and 3 cases of hepatolithiasis.17cases suffered from acute chronic cholecystitis among those 25 cases there were 5 cases of hydrocholecystis or empyema of gallbladder and 3 cases of acute obstructive suppurative cholangitis.Except 3 cases(one was cholecystolithiasis，others were hepatolithiases)were relieved through conservative treatment and rejected operation，good results were achieved in all operation cases without any complications.10 cases underwent cholecystectomy，2 cases received cholecystolithotomy；cholecystectomy and choledocholithotomy were carried out in 7 cases，2 cases received choledocholithotomy.Choledocholithotomy and left external hepatectomy were performed for 1 case.Results Follow-up for 1 to 10 years in 17 cases(77.3%)found all children grew up well，except one had occasional pain in upper abdomen.No patients were detected with recurrent or residual stones through B-ultrasound examination.Conclusion There weren’t typical clinical symptoms of cholecystolithiasis in childhood.B-ultrasound can serve as a chief adjuvant diagnosis method in patients with abdominal pain and jaundice.When B-ultrasound