Managementul laparoscopic al litiazei biliare la copii

Abstract

Scopul studiului a fost aprecierea rolului colecistectomiei laparoscopice (CL) în tratamentuul litiazei biliare la copii. Material şi metode: studiul a inclus o analiză retrospectivă a foilor de observaţie a 21 de copii cu litiază biliară supuşi CL în Centrul Naţional Ştiinţifico-practic de Chirurgie Pediatrică “Academician Natalia Gheorghiu” în perioada decembrie 2015-martie 2019. Indicii analizaţi au inclus caracteristicele demografice, evoluţia clinică, explorările hematologice, investigaţiile imagistice, tehnica operatorie, complicaţiile postoperatorii, vindecarea postoperatorie şi diagnosticul histopatologic. Rezultate: În studiu au fost incluşi 21 de copii cu litiază biliară operaţi prin CL (8 băieţi şi 13 fete). Vârsta medie a fost de 8,3 ani (3-17 ani). 20 de copii cu fost cu litiază biliară simptomatică şi 1 copil cu litiază asimptomatică, dar cu sferocitoză ereditară. La 7 copii au fost depistaţi factori etiologici de risc pentru dezvoltarea litiazei biliare, restul 14 pacienti au fost cu colelitiază idiopatică. 17 copii au fost cu calculi pigmentari şi 4 - cu calculi colesterolici. Copiii au fost supuşi CP programate. 18 copii au suferit de colecistită cronică calculoasă şi 3 copii de colecistită acută calculoasă. La un pacient cu coledocolitiază concomitentă preoperator a fost efectuată papilosfincterotomia. Timpul mediu de operaţie a fost 56,7 minute (30-90 minute). Complicaţii postoperatorii nu au fost. Durata medie de spitalizare a fost de 4,3 zile (3-6 zile). Concluzie: Colecistectomia laparoscopică este o metodă sigura şi eficientă de tratament al litiazei biliare simptomatice la copii.

The aim of the study was to assess the role of laparoscopic cholecystectomy (LC) in the treatment of pediatric gallstone disease. Material and methods: the study was based on a retrospective analysis of medical records of 21 children with cholelithiasis treated by laparoscopic cholecystectomy in the “Natalia Gheorghiu” National Scientific and Practical Center of Pediatric Surgery between December, 2015 – March, 2019. The analyzed indices included demographic characteristics, clinical evolution, blood tests, imaging results, operative technique, postoperative complications, postoperative recovery and histological diagnosis. Results: 21 children with gallstone disease were included in the study (8 boys and 13 girls). The average age was 8,3 years (range 3-17 years). 20 children had symptomatic gallstones and 1 child had asymptomatic cholelithiasis, but he also had hereditary spherocytosis. In 7 children etiologic risk factors for gallstone disease were discovered, the rest of them were with idiopathic cholelithiasis. 17 children had pigmental stones and 4 children had cholesterol stones. The elective laparoscopic cholecystectomy was performed in all children. 18 patients suffered from chronic calculous cholecystitis and 3 children had acute calculous cholecystitis. In one child with concomitant choledocholithiasis the endoscopic papillosphincterotomy was preoperatively performed. The average surgery time was 56.7 minutes (range: 30-90 minutes). There were no postoperative complications. The average length of hospitalization was of 4.3 days (range: 3-6 days). Conclusion: Laparoscopic cholecystectomy is a safe and efficient method of symptomatic pediatric gallstones treatment.