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）》由会员上传分享，免费在线阅读，更多相关内容在工程资料-天天文库。

1、小儿胆石症诊断与治疗体会【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%

2、）随访1〜10年，生长发育良好，仅1例偶有上腹部疼痛。E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E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]ObjectiveToinvestigatethediagnosisandtreatmentofcholelithiasisinchildhood.MethodsTheclinicaldataof25casesofcholelithiasisi

3、nchildhoodovera19-yearperiodwerereviewed.19casesweremaleand6casesfemale.Theagerangedfrom5monthsto17yearsold(theaverageageis9.6years).Therewere13casesofcholecystolithiasisand9casesofcholedocholethiasisand3casesofhepatolithiasis.17casessufferedfromacutechroniccholecystitisamongthose25casest

4、herewere5casesofhydrocholecystisorempyemaofgallbladderand3casesofacuteobstructivesuppurativecholang辻is.Except3cases(onewascholecystolithiasis,otherswerehepatolithiases)wererelievedthroughconservativetreatmentandrejectedoperation,goodresultswereachievedinalloperationcaseswithoutanycomplica

5、tions.10casesunderwentcholecystectomy,2casesreceivedcholecystolithotomy;cholecystectomyandcholedocholithotomywerecarriedoutin7cases,2casesreceivedcholedocholithotomy.Choledocholithotomyandleftexternalhepatectomywereperformedfor1case.ResultsFollow-upfor1to10yearsin17cases(77・3%)foundallchi

6、ldrengrewupwell,exceptonehadoccasionalpaininupperabdomen.NopatientsweredetectedwithrecurrentorresidualstonesthroughB-ultrasoundexamination.ConclusionTherewerenJttypicalclinicalsymptomsofcholecystolithiasisinchildhood・E・ultrasoundcanserveasachiefadjuvantdiagnosismethodinpatientswithabdomin

7、alpainandjaundice.WhenB-ultrasoundandX-raywereusedcombinedly,diagnosisrateandaccuracywereelevated.Surgicaltreatmentshouldbeappliedtocasesdiagnoseddeterminedly.Choiecystectomyisaneffectivemethodtotreatcholecystolethiasisandcholedochotomyshouldbecontrolledstrictlyinus