Götz M, Granditsch G, Helmer F, Howanietz L, Wagner I U
Wien Klin Wochenschr. 1977 Oct 28;89(20):686-90.
Cholelithiasis is a rare, but important condition to be considered in the differential diagnosis of abdominal symptoms in childhood and adolescence. A survey over a 20-year period revealed 10 cases between the ages of 11 and 20 years, with a clinical history of cholelithiasis of between 5 days and 6 years. The most consistent finding was epigastric or right upper quadrant pain. Serum chemistry did not contribute conclusively towards the diagnosis. Hereditary spherocytosis was demonstrated in 3 cases, 2 had familial gall bladder disease, whilst in the rest no cause could be found. Two patients are described in some detail: one girl with spherocytosis and a bilirubin of 78 mg/100 ml, presenting with choledochal obstruction and pancreatitis, and another girl with a history of recurrent abdominal pain, negative radiologial and chemical pathological findings and a tentative diagnosis of neurosis. Oral cholecystograms lead to the diagnosis in most cases; however i. v. cholangiograms should be considered whenever the diagnosis appears in doubt. All cases were treated by cholecystectomy and recovery was uneventful in 9 patients. Cholecystectomy should be performed in all patients with gall stones, even in the absence of symptoms.
胆结石在儿童和青少年腹部症状的鉴别诊断中是一种罕见但重要的病症。一项为期20年的调查发现，年龄在11至20岁之间的有10例，胆结石临床病史在5天至6年之间。最常见的症状是上腹部或右上腹疼痛。血清化学检查对诊断并无决定性作用。3例证实有遗传性球形红细胞增多症，2例有家族性胆囊疾病，其余病例未发现病因。详细描述了2例患者：1例患有球形红细胞增多症、胆红素为78mg/100ml的女孩，表现为胆总管梗阻和胰腺炎；另1例有反复腹痛病史、放射学和化学病理学检查结果均为阴性且初步诊断为神经症的女孩。大多数病例通过口服胆囊造影确诊；然而，当诊断存疑时应考虑静脉胆管造影。所有病例均行胆囊切除术，9例患者恢复顺利。所有胆结石患者均应行胆囊切除术，即使无症状。
