小儿胆汁性腹膜炎27例诊断与治疗

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 2 7例小儿胆汁性腹膜炎的病因与诊治进行回顾分析。结果　 2 7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 (2 2 .2 % ) ,儿童 2 1例 (77.8% )。病因多与胆总管囊肿 (6 2 .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 (2 2 .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。

Diagnosis and treatment of biliary peritonitis in 27 children

Objective The purpose of this article was to consider the etiologic factors and to improve the diagnosis and treatment for the biliary peritonitis in children. Methods The etiologic factors and diagnosis and treatment of twenty seven cases of biliary peritonitis in children admitted were analysed retrospectively. Results Perforating foci in 17 cases were found, and surgery were done with the choledochotomy and celiac drainage, and the patients accompanied with cholangiectasis were treated by radical operation. Ten cases which were not seen perforating focus were done with intraperitioneal drainge, the combined with cholangiectasia operated by radical operations. There were no severe complications and death related to the operation. Among them,6 cases were infant(22.2%), 21 cases were chidren(77.8%). With respect to etiology, 62.9% of the cases were related to choledochocyst,7.45% were gallstones and roundworn,3.7% PTC injury and 22.2% were unetiology. Conclusions The misdiagnosis of biliary peritonitis in the chidren is more common. With understanding inportant point in the diagnosis and correct operation are important in improving the cure rate and reducing the complication.