Almaramhi Hamdi, Al-Qahtani Aayed R
Division of Pediatric Surgery, College of Medicine, King Khalid University Hospital, PO Box 84147, Riyadh 11671, Saudi Arabia.
J Pediatr Surg. 2006 May;41(5):943-5. doi: 10.1016/j.jpedsurg.2006.01.057.
Nonoperative management of blunt pediatric liver injuries has become the standard of care in the absence of hemodynamic instability. However, associated bile duct injuries remain as difficult challenges. Few case reports have demonstrated the benefits of conservative approaches, but others have found better outcomes with surgical intervention. In this study, we report on our experience with interventional endoscopic and radiologic management of 5 pediatric patients with bile duct injuries who underwent unsuccessful surgical interventions.
We conducted a retrospective review of medical records of all pediatric patients who were admitted with major blunt liver trauma and bile duct injuries over a period of 5 years.
There were 5 patients (4 boys and 1 girl) whose ages range from 3 to 11 years in this study. All patients had major liver laceration and bilomas. Two had intrahepatic and 3 had extra hepatic bile duct injuries (2 right hepatic ducts and 1 junction of cystic duct with common bile duct). All of them underwent previous laparotomies, once in 2 patients, twice in 2 patients, and thrice in 1 patient. All 5 patients were eventually treated successfully with interventional endoscopic and radiologic techniques. Three underwent endoscopic retrograde cholangiopancreatography stenting with percutaneous drainage. Two patients were managed with percutaneous drainage alone. The follow-up is up to 2.5 years with normal liver function test and bile duct ultrasound.
With the current advancement in endoscopic retrograde cholangiopancreatography and intervention radiology techniques, we believe that interventional endoscopic and radiologic management of bile duct injuries caused by blunt trauma in children is successful and efficacious even after multiple laparotomies.
在无血流动力学不稳定的情况下，小儿钝性肝损伤的非手术治疗已成为标准治疗方法。然而，相关的胆管损伤仍然是严峻的挑战。少数病例报告显示了保守治疗方法的益处，但也有其他研究发现手术干预能取得更好的效果。在本研究中，我们报告了5例胆管损伤小儿患者的介入内镜和放射治疗经验，这些患者此前手术干预均未成功。
我们对5年内因严重钝性肝外伤和胆管损伤入院的所有小儿患者的病历进行了回顾性研究。
本研究中有5例患者（4名男孩和1名女孩），年龄在3至11岁之间。所有患者均有严重肝裂伤和胆汁瘤。2例为肝内胆管损伤，3例为肝外胆管损伤（2例右肝管损伤，1例胆囊管与胆总管交界处损伤）。他们均曾接受过剖腹手术，2例患者手术1次，2例患者手术2次，1例患者手术3次。所有5例患者最终均通过介入内镜和放射技术成功治疗。3例患者接受了内镜逆行胰胆管造影支架置入术并经皮引流。2例患者仅接受了经皮引流。随访长达2.5年，肝功能检查和胆管超声均正常。
随着目前内镜逆行胰胆管造影和介入放射学技术的进步，我们认为即使在多次剖腹手术后，小儿钝性创伤所致胆管损伤的介入内镜和放射治疗也是成功且有效的。
