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腹腔镜在婴儿期外科相关性胆汁淤积症诊治中的应用

Applycation of laparoscopy in the diagnosis and treatment of obstructive infantile cholestasis
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摘要 目的探讨腹腔镜在婴儿期外科相关性胆汁淤积症诊断和治疗中的应用。方法回顾性分析2012年1月至2017年6月华中科技大学同济医学院附属武汉儿童医院106例经内科保守治疗2周以上,血清胆红素水平无明显下降的外科相关性胆汁淤积症患儿的临床资料。结果本组106例患儿均进行腹腔镜胆道探查及胆道造影后明确诊断,其中胆道闭锁88例(83.0%),浓缩胆栓综合征16例(15.1%),胆道发育不良2例(1.9%)。88例胆道闭锁患儿中,有38例经腹腔镜胆道探查及胆道造影明确诊断后放弃手术治疗,50例确诊后行开腹肝门空肠吻合术,胆道闭锁患儿预后不尽相同。18例非胆道闭锁患儿经腹腔镜胆囊造瘘、胆道冲洗后病情好转,黄疸消退,随访4个月~5年,均恢复良好无复发。结论腹腔镜微创技术可以对外科相关性胆汁淤积症患儿进行诊断和治疗,其临床实用价值较高。胆道闭锁患儿可以在腹腔镜下尽快明确诊断以获取手术时机。浓缩胆栓综合征及胆道发育不良患儿,可以在腹腔镜下胆道造影明确诊断后,行胆囊造瘘及胆道冲洗,以减轻胆汁淤积对肝脏的损害。 Objective To study the use of laparoscopy in the diagnosis and treatment of obstructive infantile cholestasis. Methods The clinical data of 106 patients with obstructive infantile cholestasis from January 2012 to June 2017 were studied retrospectively. After two weeks of conservative treatments which failed to decrease the bilirubin levels significantly, these patients were subjected to laparoscopic diagnosis and treatment. Results A correct diagnosis was established in all these 106 patients by laparoscopic biliary tract exploration and cholangiography. Eighty-eight patients were diagnosed to have biliary atresia (83.0%), 16 patients inspissated bile syndrome (15.1%) and 2 patients biliary hypoplasia (1.9%). Thirty-eight of the 88 biliary atresia patients gave up operative treatment after laparoscopic biliary tract exploration and cholangiography. The remaining 50 biliary atresia patients were treated with open Kasai portoenterostomy. The prognosis of the biliary atresia patients were different from the non-biliary atresia patients. On follow-up for 4 months to 5 years, all the 18 non-biliary atresia patients were in good condition and there was no recurrence of jaundice after laparoscopic cholecystostomy and biliary tract irrigation. Conclusions The laparoscopic minimally invasive technique helped to establish diagnosis and treatment in patients with obstructive infantile cholestasis. For patients with biliary atresia, this procedure gave a definitive diagnosis and offered an opportunity for surgery. For patients with inspissated bile syndrome and biliary hypoplasia patients, laparoscopic cholecystostomy and biliary tract irrigation established the correct diagnosis and reduced liver damage resulted by cholestasis.
作者 舒俊 段栩飞 卞红强 黄茂华 杨俊 闫学强 Shu Jun;Duan Xufei;Bian Hongqiang;Huang Maohua;Yang Jun;Yan Xueqiang(Department of General Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China)
出处 《中华肝胆外科杂志》 CAS CSCD 北大核心 2019年第2期111-115,共5页 Chinese Journal of Hepatobiliary Surgery
关键词 腹腔镜检查 胆道外科手术 胆道疾病 胆道闭锁 婴儿 新生 疾病 Laparoscopy Biliary tract surgical procedure Biliary tract diseases Biliary atresia Infant, newborn, disease
作者简介 通信作者:段栩飞,Email:alendxf6@hotmail.com.
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