[1]裴 薇 高明太 刘登瑞 吴玲玲.国内小儿自发性胆道穿孔320例临床荟萃分析[J].临床小儿外科杂志,2013,12(02):113-116.[doi:10.3969/j.issn.1671— 6353.2013.02.011]
PEI Wei,GAO Ming-tai,LIU Deng-rui,et al.Domestic pediatric spontaneous biliary perforation in 320 cases of clinical meta-analysis[J].Journal of Clinical Pediatric Surgery,2013,12(02):113-116.[doi:10.3969/j.issn.1671— 6353.2013.02.011]
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PEI Wei,GAO Ming-tai,LIU Deng-rui,et al.Domestic pediatric spontaneous biliary perforation in 320 cases of clinical meta-analysis[J].Journal of Clinical Pediatric Surgery,2013,12(02):113-116.[doi:10.3969/j.issn.1671— 6353.2013.02.011]
国内小儿自发性胆道穿孔320例临床荟萃分析
《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R]
卷:
第12卷
期数:
2013年02期
页码:
113-116
栏目:
论著
出版日期:
2013-04-28
- Title:
- Domestic pediatric spontaneous biliary perforation in 320 cases of clinical meta-analysis
- Keywords:
- Biliary Tract Diseases/DI; Biliary Tract Diseases/TH; Child
- 摘要:
- 目的 汇总分析最近22年国内报道的小儿自发性胆道穿孔(Spontaneous perforation of the bile duct,SPBD)病例,探讨国内SPBD的临床特点及诊疗策略。 方法 检索中国知网中国期刊全文数据库、万方期刊全文数据库、维普中文科技期刊数据库,提取符合标准的文献资料进行总结分析。 结果符合纳入标准的SPBD共320例,男:女为1:1.74,平均年龄3.82岁。主要临床表现为腹胀(86.8%),呕吐(76.8%),腹痛(75.8%),发热(68.8%),黄疸(38.6%),白陶土样便(23.5%),移动性浊音阳性(31.5%),右上腹包块(16.0%),随病程发展,可出现腹膜刺激征(46.6%),肠鸣音减弱或消失(27.6%)。术前确诊仅75例,确诊率为23.4%,其中71例(占确诊病例的 94.7%)通过腹腔穿刺术确诊,245例(76.6%)经手术确诊。均行手术治疗,首次手术治疗方式为T管引流加腹腔引流术者占63.2%,单纯腹腔引流术占14.7%,胆囊造瘘引流术占7.2%,Ⅰ 期肝管空肠Roux-en-Y吻合术占2.0%,50.2%行 Ⅱ 期胆道重建术。死亡率为6.9%。 结论 小儿自发性胆道穿孔病情进展快,可通过临床表现结合腹腔穿刺术、腹部超声及CT检查早期确诊,积极手术治疗是治疗本病及降低死亡率的关键。
- Abstract:
- Objetive To analyze the reports of spontaneous perforation of the bile duct in infancy and childhood(SPBD)in the last 22 years and to explore the domestic the SPBD clinical presentation and management. Methods Searches were carried out using CNKI, Wanfang Data and VIP Chinese Periodical Database, extract the standards-compliant of clinical data to summarize and analyze. Results In total, 320 cases of SPBD were identified, male:female=1:1.74, the average age was 3.82 years. The most common presenting symptom was abdominal distension(86.8%), vomiting(76.8%), abdominal pain(75.8%), fever(68.8%), jaundice(38.6%), pale-coloured stools(23.5%), shifting dullness(31.5%),right upper quadrant mass(16.0%), with the progression of course of SPBD, peritoneal irritation(46.6%), bowel sounds diminished or disappeared(27.6%)will appear. These confirmed only 75 cases without surgery, the rate of preoperative diagnosis was 23.4%, of which 71 cases(94.7%)of the confirmed cases diagnosed by abdominal paracentesis, 245 cases(76.6%)confirmed by surgery. All cases had surgical treatment. There were several methods of management in first surgery, including both T-tube drainage and abdominal drainage(63.2%), peritoneal drainage alone(14.7%), gallbladder fistula drainage(7.2%), Roux-en-Y hepaticojejunostomy atⅠstage(2.0%), 50.2% of these subsequently required biliary reconstruction atⅡstage. The mortality rate was 6.9%. Conclusions The disease of children has a rapid progress, early diagnosis can be by clinical manifestations abdominal paracentesis and abdominal ultrasound scan or computed tomography(CT),active surgical treatment is the key to treat SPBD and reduce mortality.
参考文献/References:
1 Evans K, Marsden N, Desai A. Spontaneous perforation of the bile duct in infancy and childhood: a systematic review[J]. Journal of pediatric gastroenterology and nutrition, 2010. 50(6): 67 7— 681. 2张晋楚, 施伟栋, 黄伟. 小儿胆管自发性穿孔29例诊治体会[J]. 陕西医学杂志, 2009(09): 116 5— 1166. 3印其友, 周以明, 肖现民. 小儿胆道穿孔的诊治经验[J]. 临床小儿外科杂志, 2004(02): 8 8— 91. 4Gobbi D. Conservative treatment of spontaneous biliary perforation[J]. Pediatr Int, 2011. 53(4): 59 4— 595. 5Barnes BH, Narkewicz MR, Sokol RJ. Spontaneous perforation of the bile duct in a toddler: the role of endoscopic retrograde cholangiopancreatography in diagnosis and therapy[J]. Journal of pediatric gastroenterology and nutrition, 2006. 43(5): 695.
更新日期/Last Update:
2013-04-30