Tuna Kirsaclioglu Ceyda, Çuhacı Çakır Bahar, Bayram Gulsah, Akbıyık Fatih, Işık Pamir, Tunç Bahattin
Department of Pediatric Gastroenterology, Ankara Child Health and Diseases Hematology-Oncology Research and Training Hospital, Ankara, Turkey.
Well Child Clinic, Ankara Child Health and Diseases Hematology-Oncology Research and Training Hospital, Ankara, Turkey.
J Paediatr Child Health. 2016 Oct;52(10):944-949. doi: 10.1111/jpc.13235. Epub 2016 May 28.
The aim of this study was to evaluate the clinical presentation, risk factors, complications, treatment and outcomes of cholelithiasis in children.
Children with cholelithiasis were reviewed for demographic information, predisposing factors, presenting symptoms, laboratory findings, complications, treatment and outcome, retrospectively.
A total of 254 children with cholelithiasis (mean age: 8.9 ± 5.2 years) were recruited to the study. Girls (52.8%) were significantly older than boys (P < 0.001). Symptomatic patients (59%) were significantly older than asymptomatic patients (P = 0.002). Abdominal pain was the most frequent symptom. No risk factors were identified in 56.6% of the patients. Ceftriaxone (20%) was the most commonly associated risk factor. At presentation, at least one of the following complications was seen in 14.1% of patients: cholecystitis (10.9%), obstructive jaundice (2.7%), pancreatitis (1.96%) and cholangitis (1.2%). There was no relationship between gallstone size and symptoms, aetiological factors and complications. The cholelithiasis dissolution rate was higher in younger children (P = 0.032), in those with biliary sludge (P < 0.0001) and ceftriaxone-related cholelithiasis (P < 0.001). Haemolytic anaemia (P = 0.001) and older age (P = 0.002) were associated with stable stones. Ursodeoxycholic acid was administered to 94.4% of patients at presentation. Twenty-nine patients underwent cholecystectomy, and seven patients underwent endoscopic retrograde cholangiopancreotography. Patients who were symptomatic at presentation had significantly more frequent symptoms at follow-up (P < 0.001) CONCLUSIONS: Dissolution rate of cholelithiasis was higher in younger children, biliary sludge formation and ceftriaxone-related cholelithiasis but lower in older children and haemolytic anaemia-related cholelithiasis.
本研究旨在评估儿童胆结石的临床表现、危险因素、并发症、治疗方法及预后。
对患有胆结石的儿童进行回顾性研究，分析其人口统计学信息、诱发因素、症状表现、实验室检查结果、并发症、治疗方法及预后。
共有254名胆结石患儿（平均年龄：8.9±5.2岁）纳入本研究。女孩（52.8%）的年龄显著大于男孩（P<0.001）。有症状的患者（59%）年龄显著大于无症状患者（P = 0.002）。腹痛是最常见的症状。56.6%的患者未发现危险因素。头孢曲松（20%）是最常见的相关危险因素。就诊时，14.1%的患者出现至少一种以下并发症：胆囊炎（10.9%）、梗阻性黄疸（2.7%）、胰腺炎（1.96%）和胆管炎（1.2%）。胆结石大小与症状、病因及并发症之间无关联。年龄较小的儿童（P = 0.032）、有胆泥的儿童（P<0.0001）以及与头孢曲松相关的胆结石患儿（P<0.001）的胆结石溶解率较高。溶血性贫血（P = 0.001）和年龄较大（P = 0.002）与结石稳定有关。94.4%的患者在就诊时接受了熊去氧胆酸治疗。29例患者接受了胆囊切除术，7例患者接受了内镜逆行胰胆管造影术。就诊时有症状的患者在随访时症状出现频率显著更高（P<0.001）。结论：年龄较小的儿童、胆泥形成以及与头孢曲松相关的胆结石的胆结石溶解率较高，但年龄较大的儿童和与溶血性贫血相关的胆结石的溶解率较低。
