CAJ | 학술논문

目的探讨小儿胆道穿孔的病因、临床特点及诊疗方案.方法对2009年4月至2014年4月武汉市儿童医院收治的7例胆道穿孔患儿临床资料进行回顾性分析.结果胆道穿孔患儿共7例,其中男1例,女6例;平均年龄2.05岁.主要临床表现为腹胀7例(100.0％),恶心、呕吐6例(85.7％),腹痛5例(71.4％),黄疸、腹泻各1例(各14.3％).术前行腹腔穿刺检查6例,均穿出胆汁性腹水;行腹部超声检查5例,均提示腹腔积液;行腹部CT检查5例,亦均提示腹腔积液.术中发现穿孔部位在肝总管与胆囊管汇合处3例(42.8％)、肝总管1例(14.3％)、胆总管1例(14.3％),未发现穿孔部位2例(28.6％).对穿孔口径较大(例1、2、5、7)的患儿,行开腹或腹腔镜T管引流+腹腔引流术;对穿孔口径较小(例4)和未发现穿孔部位(例3、6)的患儿,行开腹或腹腔镜胆囊造瘘+腹腔引流术;对例4患儿行胆道穿孔修补.其中例4、5术后反复出现腹痛不适,行腹部CT检查提示胆道扩张,遂行胆道重建术,术后患儿均恢复良好;其他5例患儿胆道穿孔术后随访7个月～5年,均恢复良好,未见术后并发症.结论小儿胆道穿孔可通过临床表现、腹部超声及CT、腹腔穿刺术早期确诊,一旦确诊,需积极手术,应结合胆道穿孔口径的大小选择合适的手术引流方案;对反复腹痛、合并胆道扩张症的患儿,需行胆道重建术.
목적 탐토소인담도천공적병인、림상특점급진료방안.방법 대2009년4월지2014년4월무한시인동의원수치적7례담도천공환인림상자료진행회고성분석.결과 담도천공환인공7례,기중남1례,녀6례;평균년령2.05세.주요림상표현위복창7례(100.0％),악심、구토6례(85.7％),복통5례(71.4％),황달、복사각1례(각14.3％).술전행복강천자검사6례,균천출담즙성복수;행복부초성검사5례,균제시복강적액;행복부CT검사5례,역균제시복강적액.술중발현천공부위재간총관여담낭관회합처3례(42.8％)、간총관1례(14.3％)、담총관1례(14.3％),미발현천공부위2례(28.6％).대천공구경교대(례1、2、5、7)적환인,행개복혹복강경T관인류+복강인류술;대천공구경교소(례4)화미발현천공부위(례3、6)적환인,행개복혹복강경담낭조루+복강인류술;대례4환인행담도천공수보.기중례4、5술후반복출현복통불괄,행복부CT검사제시담도확장,수행담도중건술,술후환인균회복량호;기타5례환인담도천공술후수방7개월～5년,균회복량호,미견술후병발증.결론 소인담도천공가통과림상표현、복부초성급CT、복강천자술조기학진,일단학진,수적겁수술,응결합담도천공구경적대소선택합괄적수술인류방안;대반복복통、합병담도확장증적환인,수행담도중건술.
Objective To explore the etiology,clinical characteristics,diagnosis and treatment of the bile duct perforation in children.Methods The clinical data of 7 children with the bile duct perforation were retrospectively summarized in Wuhan Children's Hospital from April of 2009 to April of 2014.Results There were 7 cases of the children with perforation of the bile duct,1 male and 6 female,the average age was 2.05 years.The most common presenting symptoms were abdominal distension in 7 cases(100.0％),nausea and vomiting in 6 cases(85.7％),abdominal pain in 5 cases(71.4％),jaundice in 1 case(14.3％) and diarrhea in 1 case(14.3％).Six cases experienced preoperative abdominal paracentesis,which all gained bilious ascites.Both abdominal ultrasound and computed tomography(CT) showed ascites in 5 cases.On exploration,sites of perforation were seen in 3 cases(42.8％) at the junction of the common hepatic duct and cystic duct,1 case(14.3％) at common hepatic duct,and 1 case(14.3％) at common bile duct,while sites of perforation in other 2 cases(28.6％) were not localized.In the cases(case 1,2,5 and 7) whose site of perforation was large,the T-tube drainage and peritoneal drainage through laparotomy or laparoscopic surgery was performed.In case 4 whose site of perforation was very small,and case 3 and 6 whose site of perforation was not localized,the cholysystostomy and peritoneal drainage was performed through laparotomy or laparoscopic surgery.Simple closure of the perforation was performed in case 4.Case 4 and 5 showed recurrent abdominal pain after operation and abdominal CT revealed biliary tract dilatation,and then biliary reconstruction was performed.Both of the patients recovered well postoperatively.The other 5 children recovered well and had an uneventful postoperative period from the 7 months to 5 years follow-up.Conclusions Early diagnosis of perforation of the bile duct can be made based on clinical manifestations,abdominal ultrasound and CT and abdominal paracentesis.Active surgical treatment should be performed once diagnosis was made.Depending on the size of perforation of the bile duct,appropriate surgical drainage scheme is made.The children with recurrent abdominal pain and biliary tract dilatation should receive biliary reconstruction.