摘要
目的总结10年来118例胆道闭锁诊断治疗的经验。方法通过观察患儿大便、肝脏体检、B超和ECF可迅速早期确诊。采用的基本术式为肛门空肠吻合术，行Kasai术Ⅰ式（肝门空肠Roux-Y吻合）10例，Kasai术Ⅱ式（肛门胆囊吻合术）3例，Suruga术式（肛门空肠吻合，空肠皮肤造疾术）60例，KasaiⅠ式加矩形防反流瓣35例，单纯肝活检9例，肝移植1例。结果105例术后有胆汁排出，最多500ml/天，平均100～200m/天，亦有少于20ml／天。再次行肛门空肠吻合术19例，10例术后重新有胆汁排出。存活47例（47／108，43．5％），近3年随着诊断治疗方法不断改进，存活率已上升至63.8％（23/86），最长10年，最短7个月，天黄疸生存42人。结论提高疗效的关键是早期诊断，争取40～60天内手术，术中正确解剖肛门，术后积极防治胆管炎。黄疸消退快，肝功能恢复好的患儿，其体格和智力发育可达到正常儿童水平。
Objective To review the experience of managing 118 children with biliare atresia over the last 10 years. Methods An early diagnosis was confirmed by jaundiced infants with clay-colored feces and enlared, firm liver, ultrasonography, and hepatic scintigraphy. The basic operative procedure was hepticoejunostomy,including Kasei Ⅰ procedure (hepaticojejunostomy,Roux-Y anastomosis) in 10 cases,Kasai Ⅱ procedure (hepaticocystostomy) in 3, Suruga Ⅱ procedure (hepaticojejunostomy with a jejunal fistula) in 60, Kasai Ⅰprocedure plus antireflux valves 35, liver biopsy 9 and liver transplantation 1. Re-sults Bile drainag was recorded in 105 patients with mean voume of 100-200 mls/day (range= 20 to 500mls/day). 19 patiens underwent re- hepaticojejunostomy,and 10 of them had bile excretion post-opera-tively. The overall survival rate was 43% (47/108). The survival rate over the las three years improved to 63% (23/36). The duration of survival ranged from 7 month to 10 years. Forty-two patients were jaun-dice-free. Conclusions Early diagnosis and operation preferably within 40-60 dsys, accurate diddection of porta hepatis and active treatment of cholangitis may improve the prognosis. Those children with normal liver function tests enjoy normal development.
出处
《中华小儿外科杂志》
CSCD
1999年第6期340-342,共3页
Chinese Journal of Pediatric Surgery
