Tsakayannis D E, Kozakewich H P, Lillehei C W
Department of Surgery, Children's Hospital, Boston MA 02115, USA.
J Pediatr Surg. 1996 Jan;31(1):127-30; discussion 130-1. doi: 10.1016/s0022-3468(96)90334-6.
Acalculous cholecystitis (AC) is a rare disease in children, and its spectrum has not been well established. Twenty-five children with AC were identified (treated between 1970 and 1994) by retrospective clinical and pathological review. The authors recognized two distinct forms of this disease: acute (duration of symptoms < 1 month) and chronic (duration > 3 months). Thirteen children had acute AC. Seventy-five percent were males; the age range was from 2 months to 20 years. Of these cases, six occurred in the immediate postoperative period, five were in association with a systemic medical illness, and two had an infectious cause (Salmonella). The mean time of onset of symptoms ranged from 4 to 30 days after surgery or hospitalization (mean, 16 days). All children presented with fever, right-upper-quadrant pain, and vomiting. Other manifestations included jaundice (38%) and right-upper-quadrant mass (23%). Most had leukocytosis (76%) and abnormal liver function test results (62%). Ultrasonography was the most commonly used radiological test, and all 10 cases tested met the ultrasonographic criteria for acute AC. Cholecystectomy was performed in nine children, and pathological examination confirmed cholecystitis. No postoperative complications occurred. The other four children were managed nonoperatively with intravenous antibiotics. One died, but the other three recovered fully. Twelve children had chronic AC. Sixty-seven percent were females; the age range was 7 to 18 years. All presented with chronic symptoms of right-upper-quadrant pain and nausea or vomiting. The leukocyte count and results of liver function tests were normal. Seventy-five percent had evidence of abnormal gallbladder function (noted by a radionuclide hepatobiliary scan or cholecystography). All children in this group underwent cholecystectomy, with pathological confirmation of chronic inflammation. No complications occurred, and all patients had complete resolution of symptoms. The authors conclude that AC in children occurs in two distinct patterns. The acute and chronic forms differ in their clinical setting and presentation. Cholecystectomy is effective treatment of AC, although there may be a role for nonoperative management in selected cases.
无结石性胆囊炎（AC）在儿童中是一种罕见疾病，其疾病谱尚未完全明确。通过回顾性临床和病理检查，确定了25例患有AC的儿童（于1970年至1994年间接受治疗）。作者认识到这种疾病有两种不同形式：急性（症状持续时间<1个月）和慢性（症状持续时间>3个月）。13例儿童患有急性AC。其中75%为男性；年龄范围为2个月至20岁。在这些病例中，6例发生在术后即刻，5例与全身性内科疾病相关，2例有感染原因（沙门氏菌）。症状出现的平均时间为手术后或住院后4至30天（平均16天）。所有儿童均出现发热、右上腹疼痛和呕吐。其他表现包括黄疸（38%）和右上腹肿块（23%）。大多数患儿有白细胞增多（76%）和肝功能检查结果异常（62%）。超声检查是最常用的影像学检查，所有接受检查的10例病例均符合急性AC的超声诊断标准。9例儿童接受了胆囊切除术，病理检查证实为胆囊炎。术后无并发症发生。另外4例儿童采用静脉抗生素非手术治疗。1例死亡，但其他3例完全康复。12例儿童患有慢性AC。其中67%为女性；年龄范围为7至18岁。所有患儿均表现为右上腹疼痛以及恶心或呕吐的慢性症状。白细胞计数和肝功能检查结果正常。75%的患儿有胆囊功能异常的证据（通过放射性核素肝胆扫描或胆囊造影检查发现）。该组所有儿童均接受了胆囊切除术，病理证实为慢性炎症。无并发症发生，所有患者症状完全缓解。作者得出结论，儿童AC有两种不同模式。急性和慢性形式在临床背景和表现上有所不同。胆囊切除术是治疗AC的有效方法，尽管在某些特定病例中，非手术治疗可能也有作用。
