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【摘要】 ：［目的］探讨小儿胆囊炎胆石症的临床特点、诊断与治疗方法。［方法］ 回顾性总结14年间收治的小儿胆囊炎胆石症21例的临床资料,对其临床特点、诊疗方法以及随访资料进行分析。 ［结论］门诊首诊为胆囊炎12例，误诊率为 42.86%。其中7例施行手术治疗，病理检查提示急性胆囊炎5例，慢性胆囊炎2例；胆固醇结石5例，混合性结石2例。2例拒绝手术者经保守治疗症状好转后出院。12例无胆石症的急性单纯性胆囊炎患儿给予短期禁食、纠正水电解质失衡、抗感染、解痉、利胆等治疗，住院10～21d治愈出院。 ［结论］小儿胆囊炎胆石症发病率低,缺乏典型症状,临床易误诊,诊断明确后应及时治疗。
【关键词】 小儿胆囊炎；胆石症；临床特点；诊断与治疗
Abstract：［Objective］To discuss the clinical features, diagnosis and treatment of children cholecystitis cholelithiasis.［Method ］ Trace back and sum up 21 cases in 14 years, make analysis on their clinical features, diagnosis and treatment and followup data.［Result］12 cases of first diagnosis of cholecystitis, the misdiagnosis rate 42.86%; among which, 7 were operated, whose pathological exam showed 5 cases of acute cholecystitis and 2 chronic one; 5 cholesterol gallstone, 2 mixed gallstone; 2 refused operation and were better after preserved treatment then left hospital, 12 cases of acute pure cholecystitis, without cholelithiasis, were fasting for short time, correcting unbalanced electrolyte, antiinfection, removing spasm, relieving gallbladder, and left hospital after being 10～21d in hospital and cured.［Conclusion］ There’s low occurrence rate of children cholecystitis cholelithiasis, lacking typical symptoms, easily causing misdiagnosis; intime treatment shall be made after correct diagnosis.
Key words：children cholecystitis; cholelithiasis; diagnosis and treatment
随着影像诊断学的进步与广泛应用，使过去认为罕见的小儿胆囊炎胆石症的诊断水平有所提高。我院儿科1994年1月至2008年2月共收治小儿胆囊炎胆石症21例，现总结报告如下。
1 临床资料
本组 21例患儿中中男13例，女8例中年龄2岁～14岁，平均(7.31±2.66)岁。急性单纯性胆囊炎12例，胆囊炎胆囊结石伴肝胆管结石3例，结石性胆囊炎6例。首发症状：上腹痛8例，脐周痛7例，下腹痛3例，全腹痛2例，头痛1例，摄油脂食物诱发疼痛8例，发热9例，恶心、呕吐12例。体征：皮肤黄疸3例，右上腹压痛8例，局部肌紧张7例，莫菲征阳性7例，可疑3例，阴性11例。既往有胆道蛔虫症者1例，急性胃炎3例，肠道蛔虫症3例。实验室检查：末梢血白细胞数均有不同程度升高，＞15×109/L者15例，（10～15）×109/L者6例，8例有核左移及中毒颗粒；生化检查：3例谷丙转氨酶及胆红素升高。B超检查：21例均有不同程度胆囊壁增厚、毛糙，12例急性发作者伴胆囊充血、水 [1] [2] 下一页 |
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