Kim Young A, Kim Gyung Min, Chun Peter, Hwang Eun Ha, Mun Sang Wook, Lee Yeoun Joo, Park Jae Hong
Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea.
Department of Pediatrics, Good Gang-An Hospital, Ulsan, Korea.
Pediatr Gastroenterol Hepatol Nutr. 2018 Jul;21(3):203-208. doi: 10.5223/pghn.2018.21.3.203. Epub 2018 Jun 28.
The aim of this study was to describe our treatment experiences with patients who had acute abdomen (AA) with common bile duct (CBD) dilatation.
The treatment outcomes in children with AA and CBD dilatation were retrospectively reviewed. According to the shape of the intrahepatic bile ducts on ultrasonography (US), the origin of the pain was estimated as choledochal cyst (CC) complication or choledocholithiasis in normal CBD. Patients with complicated CC underwent surgery, and patients with choledocholithiasis in a normal appearing CBD underwent symptomatic treatment initially.
Of the 34 patients, 30 (88.2%) were female. The mean age of the patients was 6.4±4.9 (range, 0.8-17) years. Seventeen (50.0%) patients had CBD stones and 17 (50.0%) did not. Surgical treatment was performed in 20 (58.8%) patients, 2 of whom underwent preoperative stone removal with endoscopic retrograde cholangiopancreatography and an operation. Conservative treatment was applied in 12 (35.3%) patients (8 with and 4 without stones), 1 of whom developed symptom relapse and underwent an operation. Among the 8 patients with CBD stones, 4 (4/17, 23.5%) had complete resolution of the stones and recovery of the CBD diameter after conservative treatment. US findings of patients with stone showed a fusiform or cylindrical shape of the CBD in 14 (82.4%) patients.
The presence of stones in the distal CBD and the US features of CBD dilatation may be helpful to diagnose and treat the causes of biliary dilatation. Conservative treatment can be considered as initial therapy in patients with uncomplicated CBD dilatation with stone.
本研究旨在描述我们对患有急性腹痛（AA）且伴有胆总管（CBD）扩张患者的治疗经验。
回顾性分析患有AA和CBD扩张患儿的治疗结果。根据超声检查（US）显示的肝内胆管形态，将疼痛来源估计为胆总管囊肿（CC）并发症或正常CBD内的胆总管结石。患有复杂CC的患者接受手术，而正常外观CBD内有胆总管结石的患者最初接受对症治疗。
34例患者中，30例（88.2%）为女性。患者的平均年龄为6.4±4.9（范围0.8 - 17）岁。17例（50.0%）患者有CBD结石，17例（50.0%）没有。20例（58.8%）患者接受了手术治疗，其中2例在术前通过内镜逆行胰胆管造影术进行了结石清除并接受了手术。12例（35.3%）患者接受了保守治疗（8例有结石，4例无结石），其中1例症状复发并接受了手术。在8例有CBD结石的患者中，4例（4/17，23.5%）在保守治疗后结石完全消失且CBD直径恢复正常。有结石患者的US表现显示，14例（82.4%）患者的CBD呈梭形或圆柱形。
CBD远端结石的存在以及CBD扩张的US特征可能有助于诊断和治疗胆管扩张的病因。对于无并发症的CBD扩张合并结石患者，可考虑将保守治疗作为初始治疗方法。
