小儿先天性胆总管囊肿自发性穿孔的临床分析

目的：探讨先天性胆总管囊肿自发性穿孔的诊断方法和手术方式。方法：回顾性分析16例先天性胆总管囊肿自发性穿孔患儿的临床资料。结果：本组16例患儿年龄均小于4岁，平均年龄23个月。临床表现为胆胀，腹痛，呕吐及发热，同时有全腹压痛，10例术前经腹腔穿刺明确胆道自发性穿孔的诊断，其中5例经B超或CT检查证实有胆总管囊肿，采用囊肿外引流加腹腔引流治疗。16例患儿术后均恢复良好，3个月左右再地囊肿切除加胆道重建。结论：先天性胆总管囊肿穿孔与胆道梗阻有关，对小婴儿有腹膜炎表现，全腹压痛并以右上腹为著者，应常规行腹腔穿刺检查，急诊治疗宜选择囊肿外引流术，而后再行囊肿切除和胆道重建。

Spontaneous perforation of choledochal cyst in children: report of 16 cases

ObjectiveTo investigate the diagnosis and operative procedure for spontaneous perforation of congenital choledochal cyst in children. MethodsThe clinical data of 16 cases with spontaneous perforation of congenital choledochal cyst were analysed retrospectively.ResultsAll cases were under 4 years old with a mean age of 23 months. Abdominal distension, pain, vomiting, fever and diffuse tenderness were present in all patients. The preoperative diagnosis was established by paracentesis in ten patients. Abdominal sonography and CT found a cyst in 5 of the 10 cases reviewed. In 11 cases (68.7%), the site of perforation was found on the confluence of common bile duct and gallbladder cystic duct. T-tube drainage was used as a transition measure. All patients recovered uneventfully. Radical resection was performed in about three months after the initial operation. ConclusionsThe obstruction of the bile duct and poor blood supply to the choledochal cyst are major causes leading to perforation. Routine abdominal paracentesis should be carried out for a small child with peritonitis and general abdominal tenderness, especially on the right upper quadrant.T-tube drainage should be adopted as an emergent procedure to tide the patient over the crisis followed by elective choledochal cyst resection and bile duct reconstruction.