Kong Chihuan,Diao Mei,Hao Xianhua,et al.Treatment of pediatric cholecystolithiasis through multiple endoscopes plus gallbladder preserving lithotomy[J].Journal of Clinical Pediatric Surgery,2022,21(07):627-631.[doi:10.3760/cma.j.cn101785-202205005-006]
多镜种联合保胆取石治疗儿童胆囊结石的疗效分析
- Title:
- Treatment of pediatric cholecystolithiasis through multiple endoscopes plus gallbladder preserving lithotomy
- Keywords:
- Choledochoscope; Laparoscope; Duodenoscope; Gallbladder-Preserving Stone Extraction; Child; Gallstone
- 摘要:
- 目的 探讨胆道镜联合腹腔镜、十二指肠镜保胆取石治疗小儿胆囊结石的方法和临床疗效。方法 2015年11月至2021年3月，首都儿科研究所附属儿童医院普外科使用胆道镜、腹腔镜、十二指肠镜治疗54例胆囊结石。其中12例伴发其他疾病（遗传性球形红细胞增多症6例，蚕豆病1例，苯丙酮尿症1例，胰腺炎1例，肾母细胞瘤化疗后1例，胆总管结石1例，胆囊息肉1例）。51例保胆取石成功，3例因结石嵌顿切除胆囊。术后对保胆取石成功的患儿进行至少12个月随访。结果 术后随访发现8例复发，总体复发率15.7%（8/51）。术前伴发其他疾病的12例中，复发5例，复发率41.7%；而未伴发疾病的39例中，复发3例，复发率7.7%（3/39）。伴有其他疾病胆囊结石的复发率明显高于无伴随疾病胆囊结石的复发率。对部分胆囊结石成分进行测定，胆固醇含量为0%~99.6%。未复发的患儿腹痛、黄疸等临床症状消失，发育良好，胆囊功能、形态均无异常。结论 采用胆道镜联合腹腔镜、十二指肠镜实施儿童保胆取石治疗胆囊结石，具有损伤小、恢复快的特点，可保留胆囊的形态和功能，促进儿童生长发育。
- Abstract:
- Objective To explore the efficacies of treating pediatric cholecystolithiasis through multiple endoscopes plus gallbladder preserving lithotomy.Methods From November 2015 to March 2021, 54 cases of cholecystolithiasis were treated by choledochoscope, laparoscope and duodenoscope.Among them, 12 children were associated with other diseases, such as hereditary globocythemia (n=6), broad bean disease (n=1), phenylketonuria (n=1), pancreatitis (n=1), post-renal chemotherapy (n=1), choledocholithiasis (n=1) and gallbladder polyp (n=1).Cholecystectomy was successful (n=51) and gallbladder was removed due to stone incarceration (n=3).Children with successful cholelithotomy were followed up for 1 year or more.Results The overall recurrence rate was 15.7%(8/51).Among 12 patients with other preoperative diseases, recurrence rate was 41.7%.In 39 cases without concomitant disease, recurrence rate was 7.7%(3/39).The recurrence rate of gallstones with other diseases was significantly higher than that without concomitant diseases.The content of cholesterol ranged from 0% to 99.6%.Children without recurrence had no abdominal pain or jaundice, decent ontogeny and normal gallbladder function and morphology.Conclusion Choledochoscope plus laparoscope and duodenoscope offer the advantages of mini-invasiveness and quicker recovery for pediatric cholecystolithotomy.Both shape and function of gallbladder are preserved and it promotes the growth and development of children.
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备注/Memo
收稿日期:2022-05-02。
基金项目:中国医学科学院小儿外科微创诊疗创新单元（2021RU015）
通讯作者:李龙,Email:lilong23@126.com