摘要
目的探讨腹腔镜胆道冲洗术在淤胆型巨细胞病毒性肝炎患儿中的应用价值。方法对我院2008年3月至2011年12月收治的淤胆型巨细胞病毒性肝炎患儿,经过2周更昔洛韦抗巨细胞病毒感染,复方甘草酸苷、腺苷蛋氨酸、熊去氧胆酸治疗后,总胆红素、直接胆红素、总胆汁酸及肝酶未下降或升高者14例,进行腹腔镜辅助下胆道探查及胆道造影,对胆汁淤积明显的12例患儿予以胆道冲洗,对2例发生胆道闭锁的患儿行Kasai术。结果胆汁淤积明显的12例患儿经1～3周的胆道冲洗后病情好转,随访3个月以上均逐渐消退,2例行Kasai术的患儿,经诊治半年黄疸消退。结论对淤胆型巨细胞病毒性肝炎患儿,经抗感染、保肝、利胆、降酶治疗后病情无改善或恶化者可尽早行胆囊造瘘及胆道冲洗,可避免胆道淤积对肝脏的进一步损害,对胆道闭锁患儿可以尽早行Kasai术。
Objective To explore the therapeutic potential of laparoscopic bile duct irrigation in infant patients with cytomegalovirus hepatitis （cholestasis）.Methods Clinical data of infants（ages 1-3 years） with cytomegalovirus hepatitis（cholestasis） who were treated at our hospital from March 2008 to December 2011 were retrieved.Fourteen infants who were unresponsive to drug treatment with gancilovir,glycyrrhizin, S -adenosylmethionine,and ursodeoxycholic acid（as evidenced by no change in total bilirubin,direct bilirubin,total bile acid, or alanine aminotransferase） were treated with surgery;12 received laparoscopic bile duct irrigation and intraoperative cholangiogram,and two underwent the Kasai operation for biliary atresia.Results The 12 infants who received laparoscopic bile duct irrigation showed marked improvement within one to three weeks after surgery.At the 3 - month follow - up,all 12 showed improvement in jaundice signs.The two infants treated with the Kasai operation showed jaundice recovery at the 6 - month follow - up.Conclusion A combined surgical strategy of cholecystostomy and laparoscopy bile duct irrigation is an effective method to reduce jaundice in infants with cytomegalovirus hepatitis（cholestasis） who are unresponsive to or experience deterioration after treatment with anti -infective drugs.This procedure may protect the liver from cholestatic injury by promoting cholagogic action and decreasing detrimental enzymatic activities.However,infants with biliary atresia may require the Kasai operation and early application may improve outcome.
出处
《临床肝胆病杂志》
CAS
2012年第12期917-918,共2页
Journal of Clinical Hepatology
关键词
腹腔镜
巨细胞病毒感染
黄疸
儿童
laparoscopes
cytomegalouirus infections
jaundice
child
