小儿自发性胆道穿孔诊治体会及病因探讨  

Diagnostic experiences and causal discussion about spontaneous biliary tract perforation in chil dren

作　　者：姚满叶[1] 黄华[1] 侯广军[1] 王献良[1] 耿宪杰[1] 张二划[1] 黄敏[1] 

机构地区：[1]郑州市儿童医院外一科,河南郑州450053

出　　处：《罕少疾病杂志》2007年第3期29-30,37,共3页Journal of Rare and Uncommon Diseases

摘　　要：目的探讨小儿自发性胆道穿孔的原因、诊断和治疗方法。方法回顾性分析8例小儿自发性胆道穿孔的临床资料。结果男2例,女6例,年龄6m～56m。入院后经腹腔穿刺或剖腹探查明确为胆道穿孔,其中6例合并有胰胆合流异常,经胆管、腹腔引流术和Ⅱ期RouX-en-Y根治术后效果满意。结论该病临床表现缺乏特异性,对其认识不足,是发生误诊、漏诊主要原因。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。早期诊断、早期手术及术后加强营养支持治疗是提高疗效的关键。合并胰胆合流异常的穿孔病例应坚持长期随访。Objective To explore the etiology, diagnosis and treatment of spontaneous biliary tract perforation in children. Methods Clinical data from 8 children with spontaneous biliary tract perforation were reviewed. Results Among all patients, there were 2 boys and 6 girls aged, 6-56 months. 8 cases were diagnosed with abdominocentesis or exploratory laparotomy after hospitalization. 6 cases, complicated with pancreaticobiliary confluence malfunction （PBCM）, underwent the total excision of dilated common biliary tract and Roux-en-Y hepaticojejunostomy in stage Ⅱ after drainage and the radical operation. Conclusion The clinical manifestation of this disease is absence of particular trait. The important reason of misdiagnosis is lack of sufficient understanding. Pancreaticobiliary confluence malfunction （PBCM） might contribute to the spontaneous biliary tract perforation in children. Abdominocentesis can raise the pre-operation diagnostic rate of spontaneous biliary tract perforation in children. The key to the improverment of curative effect is an early diagnosis and operation, postoperative nutrition treatment to support. The PBCM children must be followed up for a long term.

关 键 词：小儿 自发性胆道穿孔 诊断 治疗 病因 

分 类 号：R575[医药卫生—消化系统]