Laparoscopic cholecystectomy in children: Lessons learned from the first 100 patients
Laparoscopic cholecystectomy in children: Lessons learned from the first 100 patients
复制标题
DOI：
10.1016/s0022-3468(99)90159-8
复制
发表时间：
1999-08-01
影响因子：
2.4
通讯作者：
Shyr, Y
中科院分区：
文献类型：
--
作者：
Holcomb, GW;Morgan, WM;Shyr, Y
背景/目的：腹腔镜胆囊切除术在成人中是一种非常常见的手术，但在儿童中相对较少。100例连续的婴儿和儿童接受腹腔镜胆囊切除术，从1990年至1998年进行回顾性分析，看看有什么经验教训，从这个相对较大的人口的儿科patients.Results：患者的年龄范围从25至230个月，平均105个月。仅19例患者的病因是溶血性疾病。2例患者出现胆道运动障碍。78例患者接受了择期手术。22名儿童因胆石症并发症需要紧急住院治疗：急性胆囊炎（n = 7），黄疸和疼痛（n = 6），胆源性胰腺炎（n = 5），急性胆绞痛（n = 4）。所有6例黄疸患者在腹腔镜胆囊切除术前均接受了内镜逆行胰胆管造影术（ERCP）。2例患者需要腹腔镜胆总管探查术。与择期患者相比，复杂组的手术时间和术后住院时间显著延长（P = 0.0005）。结论：腹腔镜胆囊切除术是一种安全、有效的儿童胆囊切除术，常规胆道造影和ERCP的确切作用尚不清楚。版权所有（C）1999 W.B.桑德斯公司
Background/Purpose: Laparoscopic cholecystectomy is a very common operation in adults but is relatively infrequently required in children. A retrospective review of 100 consecutive infants and children undergoing laparoscopic cholecystectomies from 1990 to 1998 was performed to see what lessons have been learned from this relatively large population of pediatric patients.Results:The patients ranged in age from 25 to 230 months, with a mean of 105 months. Only 19 patients had hemolytic disease as the etiology for their cholelithiasis. Two patients had biliary dyskinesia. Seventy-eight patients underwent an elective operation. Twenty-two children required urgent hospitalization because of complications from their cholelithiasis: acute cholecystitis (n = 7), jaundice and pain (n = 6), gallstone pancreatitis (n = 5), acute biliary colic (n = 4). All 6 patients who presented with jaundice underwent endoscopic retrograde cholangiopancreatography (ERCP) before their laparoscopic cholecystectomy. Two patients required laparoscopic choledochal exploration. The operating time and postoperative hospitalization were significantly longer (P = .0005) in the complicated group when compared with the elective patients. No significant complications such as the need for reoperation, injury to the choledocuhus or to other viscera, bile leak, or retained choledocholithiasis occurred.Conclusions: Laparoscopic cholecystectomy is a safe, effective procedure in children for removal of the gallbladder, The exact role of routine cholangiography and ERCP remains unclear. Copyright (C) 1999 by W.B. Saunders Company.