婴儿阻塞性黄疸的腹腔镜早期干预与治疗  

Laparoscopic therapy for infant obstructive jaundice

作　　者：高志刚[1] 熊启星[1] 冯志刚[1] 钭金法[1] 王金湖[1] 黄寿奖[1] 钱云忠[1] 

机构地区：[1]浙江大学医学院附属儿童医院普外科,杭州310003

出　　处：《中华普通外科杂志》2010年第2期119-121,共3页Chinese Journal of General Surgery

基　　金：浙江省科技厅科研项目（2004c33034）;浙江省教育厅科研项目（Y200804902）

摘　　要：目的探讨腹腔镜胆道探查对婴儿阻塞性黄疸的诊断和治疗价值。方法对56例经内科保守治疗2周血清胆红素水平无明显下降的阻塞性黄疸婴儿进行胆道探查及胆道造影，并对诊断明确的非先天性胆道闭锁患儿予以胆道冲洗。结果本组56例婴儿经腹腔镜胆道探查及胆道造影后均明确诊断，其中浓缩胆栓综合征12例（21％），胆管发育不良4例（7％），胆道闭锁40例（72％）。16例非先天性胆道闭锁患儿经胆囊造瘘、胆道冲洗后病情好转，黄疸消退，随访6～42个月，均恢复良好无复发。结论利用腹腔镜早期干预阻塞性黄疸患儿可以对疾病进行早期的诊断和治疗，具有较高的临床实用价值。对浓缩胆栓综合征及先天性胆管发育不良患儿，可以在镜下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进一步损害；对胆道闭锁患儿可以争取到早期手术的时机。Objective To explore the value of early laparoscopic intervention in infant cholestatic jaundice. Method 56 cholestatic jaundiced infants underwent early laparoscopic biliary tract exploration and cholangiography after two weeks of regular conservative treatments, which failed to decrease bilirubin level significantly. The non-congenital biliary atresia patients with definite preoperative diagnosis received biliary tract irrigation. Results Correct diagnosis was established in all those 56 patients by laparoscopie procedures. Among those, 12 cases were diagnosed as cholestatic syndrome（21% ） ,4 cases were diagnosed as congenital bile duct dysplasia（7% ）, 40 cases were diagnosed as biliary atresia（72% ）. 16 cases who were diagnosed as non-congenital biliary atresia recovered after laparoscopic cholecystostomy and biliary tract irrigation. All infants were followed-up for 6 months to 42 months, they were all in good condition and there were no symptom recurrence. Conclusion Early laparoscopic intervention in infant with cholestatic jaundice helps to establish early diagnosis and early correct treatment. For cholestatic syndrome and congenital bile duct dysplasia patients, cholecystostomy and biliary tract irrigation reduces cholestasisinduced liver damage. For biliary atresia patients, this procedure offers an early operation opportunity.

关 键 词：黄疸 阻塞性 腹腔镜检查 胆道闭锁 婴儿 

分 类 号：R726.5[医药卫生—儿科]