Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow 226 014, Uttar Pradesh, India.
Indian Pediatr. 2010 Nov;47(11):945-53. doi: 10.1007/s13312-010-0159-2.
little is known about the epidemiology of cholelithiasis in children. Cholelithiasis and choledocholithiasis were considered to be uncommon in infants and children but have been increasingly diagnosed in recent years due to wide- spread use of ultrasonography. However, there is not much of information from India and no consensus among Indian pediatricians and pediatric surgeons regarding management of gallstones in children. Hence, the purpose of this review is to increase awareness about the management of gallstones in children.
extensive electronic (PubMed) literature search was made for this purpose and literature (original articles, clinical trials, case series, review articles) related to gallstones in children were reviewed.
the etiologies of cholelithiasis are hemolytic (20% -30%), other known etiology (40%-50%) such as total parenteral nutrition, ileal disease, congenital biliary diseases, and idiopathic (30-40 %). Spontaneous resolution of gallstones is frequent in infants and hence a period of observation is recommended even for choledocholithiasis. Children with gallstones can present with typical biliary symptoms (50%), nonspecific symptoms (25%), be asymptomatic (20%) or complicated (5% -10%). Cholecystectomy is useful in children with typical biliary symptoms but is not recommended in those with non-specific symptoms. Prophylactic cholecystectomy is recommended in children with hemolytic disorders.
儿童胆石病的流行病学知识甚少。胆石症和胆总管结石在婴儿和儿童中被认为不常见，但由于超声检查的广泛应用，近年来发病率逐渐增加。然而，来自印度的信息并不多，印度儿科医生和小儿外科医生在儿童胆囊结石的治疗方面也没有达成共识。因此，本文的目的是提高对儿童胆囊结石治疗的认识。
为此进行了广泛的电子（PubMed）文献检索，并对与儿童胆囊结石相关的文献（原始文章、临床试验、病例系列、综述文章）进行了回顾。
胆石症的病因有溶血性（20%-30%）、其他已知病因（40%-50%），如全胃肠外营养、回肠疾病、先天性肝胆疾病和特发性（30%-40%）。儿童胆囊结石常自行消退，因此即使胆总管结石也建议观察一段时间。有胆囊结石的儿童可表现为典型的胆道症状（50%）、非特异性症状（25%）、无症状（20%）或并发症（5%-10%）。对于有典型胆道症状的儿童，胆囊切除术是有用的，但不建议用于有非特异性症状的儿童。对于溶血性疾病的儿童，建议预防性胆囊切除术。
