Menon Seema, Patel Bhavesh, Saekang Eilen, Thomas Gordon, Soundappan Soundappan, Shun Albert
Department of Paediatric Surgery, Sydney Childrens' Hospitals Network, Westmead Campus, Sydney, NSW, 2145, Australia.
Pediatr Surg Int. 2011 May;27(5):537-40. doi: 10.1007/s00383-010-2826-8.
The optimal method of managing paediatric choledocholithiasis is controversial. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy are effective in adults; however, the long-term outcome in the paediatric population is unknown. We report our experience with laparoscopic common bile duct (CBD) exploration to relieve choledocholithiasis in children and propose a management algorithm.
A retrospective chart review of 124 children, who underwent cholecystectomy over 5 years was conducted. Data collected included age at onset, duration of symptoms, length of stay, method of relieving choledocholithiasis and postoperative outcome.
Mean age was 12.5 years (range 10-14 years). 102 cholecystectomies were performed laparoscopically. Following intraoperative cholangiogram (IOC), choledocholithiasis was identified in eight patients. In three cases, the CBD was flushed with normal saline via a 5F ureteral catheter successfully relieving the obstruction. In three cases, a Dormia basket was used to break down the stone. Two cases required postoperative ERCP and sphincterotomy to successfully extract the stones. All children were symptom-free at follow-up with no complications reported to date.
Laparoscopic CBD exploration with Dormia basket or saline flushes to relieve choledocholithiasis is a safe and effective alternative in children. If unsuccessful, ERCP and sphincterotomy can be performed in centres with adequate resources and expertise.
小儿胆总管结石的最佳治疗方法存在争议。内镜逆行胰胆管造影术（ERCP）及括约肌切开术在成人中有效；然而，小儿患者的长期治疗效果尚不清楚。我们报告了我们采用腹腔镜胆总管探查术治疗小儿胆总管结石的经验，并提出了一种治疗方案。
对5年间接受胆囊切除术的124例儿童进行回顾性病历审查。收集的数据包括发病年龄、症状持续时间、住院时间、胆总管结石的解除方法及术后结果。
平均年龄为12.5岁（范围10 - 14岁）。102例胆囊切除术采用腹腔镜进行。术中胆管造影（IOC）后，8例患者被确诊为胆总管结石。3例患者通过5F输尿管导管用生理盐水冲洗胆总管，成功解除梗阻。3例患者使用多尔米亚网篮碎石。2例患者术后需要行ERCP及括约肌切开术以成功取出结石。所有患儿随访时均无症状，迄今为止未报告有并发症。
对于小儿胆总管结石，采用多尔米亚网篮或生理盐水冲洗的腹腔镜胆总管探查术是一种安全有效的替代方法。若不成功，可在具备足够资源和专业技能的中心进行ERCP及括约肌切开术。
