Vinograd I, Halevy A
Dept. of Pediatric, Assaf Harofeh Medical Center, Zerifin.
Harefuah. 1992 Aug;123(3-4):89-91, 155.
Laparoscopic cholecystectomy is increasingly being used in adults with gallbladder disease. Despite the exponential increase in the number of laparoscopic cholecystectomies performed in adults, there are very few reports of its use in children. It is thought that gallstone disease is rare in childhood. Since the introduction of ultrasonography, it is used almost routinely for evaluating children with abdominal pain, and cholelithiasis is being increasingly recognized in children. Since the beginning of 1991 we evaluated 7 children for biliary colic, and on sonography gallstones were demonstrated in all of them. 1 boy also had thalassemia and another hyperlipidemia; the other 5 developed symptoms of biliary colic without any history of hematological or other disease. 5 underwent laparoscopic cholecystectomy without complication. In the other 2 laparotomy was performed. In 1 suspected damage to the common bile duct during laparoscopy required direct visualization, but no damage was found. In the other, no gallbladder was identified on laparoscopy; laparotomy confirmed the diagnosis of congenital agenesis of the gallbladder with several technical modifications. We found laparoscopic cholecystectomy to be both safe and effective in children. Its advantages include shorter hospitalization, decreased postoperative discomfort and a much shorter interval between operation and return to normal activity.
腹腔镜胆囊切除术在患有胆囊疾病的成人中使用得越来越频繁。尽管成人腹腔镜胆囊切除术的数量呈指数级增长，但关于其在儿童中的应用报道却很少。人们认为胆结石疾病在儿童时期很少见。自从超声检查引入以来，它几乎被常规用于评估腹痛儿童，儿童胆石症也越来越多地被发现。自1991年初以来，我们对7名因胆绞痛接受评估的儿童进行了检查，超声检查显示他们所有人都有胆结石。1名男孩还患有地中海贫血，另一名患有高脂血症；其他5名儿童出现胆绞痛症状，无血液学或其他疾病史。5名儿童接受了腹腔镜胆囊切除术，无并发症。另外2名儿童接受了剖腹手术。其中1名儿童在腹腔镜检查期间怀疑胆总管受损，需要直接观察，但未发现损伤。另一名儿童在腹腔镜检查中未发现胆囊；剖腹手术通过一些技术改进确诊为先天性胆囊缺如。我们发现腹腔镜胆囊切除术在儿童中既安全又有效。其优点包括住院时间缩短、术后不适减轻以及手术与恢复正常活动之间的间隔时间大大缩短。
