Wood J, Holland A J A, Shun A, Martin H C O
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, The University of Sydney, Locked Bag 4001, NSW 2145, Westmead, Australia.
Pediatr Surg Int. 2004 Feb;20(2):83-6. doi: 10.1007/s00383-003-1092-4. Epub 2004 Feb 10.
We report our experience of cholecystectomy for treating symptoms suggestive of biliary disease in association with a decreased gallbladder ejection fraction (GBEF) but without evidence of cholelithiasis. Five children with normal biliary ultrasounds were evaluated between January 1990 and December 2000 for recurrent upper abdominal pain. Based on a cholecystokinin (CCK)-provoked GBEF of less than 50% and the absence of any other gastrointestinal pathology, patients underwent cholecystectomy with operative cholangiography for presumed biliary dyskinesia. Pathological examination demonstrated chronic inflammation in all cases. Two patients had complete resolution of their symptoms, but three had persistent pain following surgery. Biliary dyskinesia seems an uncommon cause of persistent abdominal pain in childhood. Cholecystectomy was not always effective in relieving symptoms. Biliary scintigraphy with CCK provocation should not be used as the sole criterion for cholecystectomy. Sphincteric manometry may be valuable in the assessment of this small group of patients to avoid inappropriate intervention. The future perhaps lies in better understanding of the physiological action and pharmacological control of the sphincter of Oddi.
我们报告了在胆囊射血分数（GBEF）降低但无胆石症证据的情况下，行胆囊切除术治疗提示胆道疾病症状的经验。1990年1月至2000年12月期间，对5例胆道超声正常的儿童进行了复发性上腹痛评估。基于胆囊收缩素（CCK）激发后GBEF小于50%且无任何其他胃肠道病变，患者因推测的胆道运动障碍接受了胆囊切除术及术中胆管造影。病理检查在所有病例中均显示为慢性炎症。2例患者症状完全缓解，但3例术后仍有持续性疼痛。胆道运动障碍似乎是儿童持续性腹痛的罕见原因。胆囊切除术并不总是能有效缓解症状。CCK激发的胆道闪烁显像不应作为胆囊切除术的唯一标准。括约肌测压在评估这一小部分患者以避免不适当干预方面可能有价值。未来或许在于更好地理解Oddi括约肌的生理作用和药物控制。
