资源描述：
《小儿胆汁性腹膜炎27 例诊断与治疗》由会员上传分享，免费在线阅读，更多相关内容在行业资料-天天文库。
1、新乡医学院学报 JournalofXinxiangMedicalCollegeVol.17No.6Dec.2000·413·小儿胆汁性腹膜炎27例诊断与治疗12吕会增, 何俊平(1.安阳市儿童医院,河南 安阳 455000;2.南京医科大学附属南京市儿童医院,江苏 南京 210008) 摘要: 目的 探讨小儿胆汁性腹膜炎的病因,提高小儿胆汁性腹膜炎的诊治水平。方法 对27例小儿胆汁性腹膜炎的病因与诊治进行回顾分析。结果 27例中17例手术中发现穿孔灶,行胆总管引流和腹腔引流,合并胆道扩张症作二期根治术;未明确穿孔
2、灶10例,作腹腔引流,合并胆道扩张症作一期根治术。无手术死亡及严重并发症,疗效满意。其中婴幼儿6例(22.2%),儿童21例(77.8%)。病因多与胆总管囊肿(62.9%)、胆道结石与蛔虫(7.4%)、经皮肝穿刺胆道造影(PTC)损伤(3.7%)等有关,部分原因不明(22.2%)。结论 小儿胆汁性腹膜炎容易误诊,掌握其临床特点、提高诊断意识及选择合适的手术方法,是提高早期诊断率和减少并发症的关键。 关键词:儿童;胆汁性腹膜炎;胆总管囊肿 中图分类号:R656.41文献标识码:A文章编号:1004-7239(20
3、00)06-0413-02Diagnosisandtreatmentofbiliaryperitonitisin27children12LUHui-zheng,HEJun-ping(1.AnyangChildren’sHospital,NanjingChildren’sHospital)Abstract:ObjectiveThepurposeofthisarticlewastoconsidertheetiologicfactorsandtoimprovethediag2nosisandtreatmentforthe
4、biliaryperitonitisinchildren.MethodsTheetiologicfactorsanddiagnosisandtreat2mentoftwentysevencasesofbiliaryperitonitisinchildrenadmittedwereanalysedretrospectively.ResultsPer2foratingfociin17caseswerefound,andsurgeryweredonewiththecholedochotomyandceliacdraina
5、ge,andthepatientsaccompaniedwithcholangiectasisweretreatedbyradicaloperation.Tencaseswhichwerenotseenperforatingfocusweredonewithintraperitionealdrainge,thecombinedwithcholangiectasiaoperatedbyradicaloperations.Therewerenoseverecomplicationsanddeathrelatedtoth
6、eoperation.Amongthem,6caseswereinfant(22.2%),21caseswerechidren(77.8%).Withrespecttoetiology,62.9%ofthecaseswererelatedtocholedochocyst,7.45%weregallstonesandroundworn,3.7%PTCinjuryand22.2%wereunetiology.Conclu2sionsThemisdiagnosisofbiliaryperitonitisinthechid
7、renismorecommon.Withunderstandinginportantpointinthediagnosisandcorrectoperationareimportantinimprovingthecurerateandreducingthecomplication.Keywords:children;biliaryperitonitis;choledochocyst 小儿胆汁性腹膜炎病因较多,术前确诊困难。过临床症状、胰淀粉酶测定、腹腔穿刺、B超或CT检南京市儿童医院1981～1999年收治27例
8、,占同期查等明确诊断,另14例经剖腹探查而确诊。病因:胆道外科手术患儿的14.2%(27/169),现报告如胆道扩张症(囊型)术前14例,明确穿孔灶10例;胆下。总管囊肿切除Roux-y术后1例;胆总管囊肿内引流术后2例;其它胆道术后1例;胆道蛔虫、结石穿1 临床资料孔各1例;经皮肝穿刺胆管造影(percutaneoustran21.1 一般资料 本组27例
