儿童胆囊结石的诊治及腹腔镜胆囊切除术与保胆取石术的疗效评价  

The diagnosis and treatment of gallstones in children and the efficacy analysis of laparoscopic cholecystectomy and cholecystolithotomy

作　　者：范志勇[1] 胡海田[1] 刘青光[2] 孙中杰[1] 李晖[1] 刘晓刚 吴武军[1] 

机构地区：[1]陕西省人民医院,陕西西安710068 [2]西安交通大学医学院第一附属医院

出　　处：《腹腔镜外科杂志》2016年第7期547-549,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨儿童胆囊结石的临床特点及治疗方法,评价腹腔镜胆囊切除术与保胆取石术的疗效。方法:回顾分析2009年1月至2015年9月收治的32例胆囊结石患儿的临床资料。结果:32例均经B超检查确诊,3例选择定期随访,其中1例出现反复腹痛后行腹腔镜胆囊切除术,另2例中1例复查提示胆囊附壁胆固醇结晶,1例无症状继续随访。手术治疗29例,术前21例行胆囊收缩功能评估,良好19例,差2例。19例患儿胆囊功能良好,其中17例行腹腔镜保胆取石术,术后复查胆囊功能良好,2例因胆囊解剖畸形及胆囊周围炎症较重行腹腔镜胆囊切除术。余10例患儿因胆囊多发结石或充满结石、胆囊萎缩、胆囊积液等行腹腔镜胆囊切除术。术后无并发症发生,长期随访无结石复发。结论:儿童胆囊结石的治疗应综合病情施行个体化治疗,腹腔镜胆囊切除术安全、有效,在严格选择适应证的情况下腹腔镜保胆取石术可作为首选。Objective：To investigate the clinical characteristics and treatment of cholecystolithiasis in children, and evaluate the efficacy of laparoscopic cholecystectomy and cholecystolithotomy. Methods： The clinical data of 32 children who suffered from gall- stones from Jan. 2009 to Sep. 2015 were retrospectively analyzed. Results：All 32 patients were diagnosed by B-ultrasound,3 patients selected regular follow-up without therapy, 1 of them underwent laparoscopic cholecystectomy because of recurrent abdominal pain, follow-up continued in the other 2 cases because of cholesterol crystals on gallbladder wall and asymptomatic gallstones. 29 patients underwent surgical treatment, gallbladder function in 21 of them were assessed preoperatively,there were good in 19 cases and poor in 2 cases. In the 19 patients with good gallbladder function, 17 patients underwent laparoscopic cholecystolithotomy and 2 received laparoscopic cholecystectomy because of deformity of gallbladder and severe inflammation around the gallbladder. The remaining 10 patients underwent laparoscopic cholecystectomy due to multiple stones or gallbladder filled with stones, atrophic cholecystitis and gallbladder effusion. There were no surgery related complications postoperatively, and no calculi recurrence after long-term follow-up. Conclusions ：The treatment of cholecystolithiasis in children should be implemented individually in accordance with the characteristics of patients ,laparoscopic cholecystectomy is safe and effective, laparoscopic cholelithotomy can be the preferred operation when operative indications are strictly selected.

关 键 词：胆囊结石病 儿童 腹腔镜检查 胆囊切除术 保胆取石术 

分 类 号：R726.5[医药卫生—儿科]