胆道闭锁术后肝内胆管囊性扩张的诊治  

Diagnosis and treatment of portal intrahepatic biliary cyst in children with biliary atresia after portoenterostomy

作　　者：潘静[1] 郑永钦[1] 佘锦标[1] 冯运红[1] 蒋宏[1] 刘钧澄[1] 

机构地区：[1]中山大学附属第一医院小儿外科,510080

出　　处：《临床小儿外科杂志》2008年第4期7-10,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的总结胆道闭锁术后肝内胆管扩张的诊治经验,探讨葛西手术后肝内胆管扩张对患儿远期预后的影响,以及如何早期诊断和治疗。方法2003年4月至2008年3月,对3例因胆道闭锁行葛西手术的患儿进行追踪随访,3例术后均有不同程度胆管炎症状,其中1例合并门脉高压。3例行超声、CT或经皮肝穿刺置管引流(PTCD),结果显示肝内胆管囊性扩张。2例行胆管扩张与空肠胆支再吻合术,1例仅行PTCD置管引流。结果2例经手术治疗的患儿,术后黄疸消退或减轻。1例仅行PTCD的患儿肝内胆管扩张长期存在。结论肝内胆管扩张使胆管炎反复发作,特别是扩张的囊状胆管压迫门静脉,可使门静脉变窄,血流减少,致受累肝叶萎缩。胆道闭锁患儿葛西手术后应定期行超声检查,及时发现肝内胆管囊性扩张。葛西手术后肝内胆管扩张应早期诊断,早期手术治疗,术前应常规行PTCD,暂时解除胆汁淤积,并为术中定位做好准备。Objective and,To summary the experience of diagnosis and treatment of intrahepatic biliary cysts （IBCs） in patients with biliary atresia who had undergone portoenterostomy, and to discuss the outcome of such patients and to determine the best diagnosis and treatment guideline.Methods The patients with biliary atresia who underwent portoenterostomy were followed up from Apr.2003 to Mar.2008.Ultrasonography,CT or PTCD showed cystic dilatation of portal intrahepatic biliary system occurred in 3 patients and one patient even had portal hypertension.All of the three patients had cholangitis postoperatively.Two underwent second operation, and one patient did none treatment except PTCD. Results Jaundice disappeared or alleviated in patients who underwent second operation.The patient without operation had persistent intrahepatic biliary cyst. Conclusions Intrahepatic biliary cysts can induce cholangitis, and the dilated bile dust compressed the portal vein,which cause portal vein narrow and atrophy of hepatic lobes.So the children with biliary atresia after portoenterostomy should undergo ultrasonography regularly, in order to find dialated bile dust in time.PTCD should be performed before the operation, not only for bile draining, but also for localization in the procedure.

关 键 词：胆道闭锁/外科学 手术后并发症 胆管疾病/诊断 胆管疾病/治疗 

分 类 号：R726.5[医药卫生—儿科]