胆道闭锁葛西手术后肝内胆管扩张的治疗与预后分析  

The managements and prognosis of intrahepatic biliary dilatation with biliary atresia after Kasai procedure

作　　者：刘钢[1] 高昕[1] 刘树立[2] 黄柳明[1] 王伟[1] 邵培[1] 侯文英[2] 张军[2] 李龙[2] 

机构地区：[1]北京军区总医院附属八一儿童医院小儿外科,100700 [2]首都儿科研究所,北京市100020

出　　处：《临床小儿外科杂志》2010年第3期172-174,共3页Journal of Clinical Pediatric Surgery

基　　金：本研究为国家＂十一五＂科技支撑计划基金资助项目（项目号2006BA105A06）

摘　　要：目的 探讨胆道闭锁葛西手术后肝内胆管扩张（Intrahepatic biliary cysts,IBCs）的治疗选择和预后情况.方法 回顾性分析8例肝内胆管囊性扩张患儿的临床表现、治疗过程和转归,其中2例单发囊肿型胆管扩张患儿分别予手术和抗感染治疗;6例多发复杂囊肿型胆管扩张患儿均行经皮肝胆管引流术（PTCD）治疗.结果 2例单发囊肿型胆管扩张患儿疗效好,预后良好.6例多发复杂囊肿型胆管扩张患儿经PTCD引流后,2例再次开腹手术吻合;6例患儿中,3例死亡,1例行肝脏移植,1例等待肝移植,1例合并门静脉高压存活.结论 胆道闭锁葛西术后多发肝内胆管扩张（C型）常提示存在严重肝脏损伤,PTCD治疗或手术再吻合治疗多数情况下仅是姑息治疗.PTCD有助于减轻黄疸,改善肝移植术前条件;而无条件进行肝脏移植的患者,单纯PTCD很难长期控制临床症状,应选择再次手术行扩张胆管肠吻合手术.单发肝内胆管扩张（A型）临床过程和预后明显优于C型扩张,可能与肝脏受损程度较轻有关.Abjective To investigate the managements and prognosis of bilial7 atresia children with intrahepatic biliary cysts after Kasai procedure. Methods 8 cases of intrahepatic biliary cysts were reviewed about the clinic features, therapy and prognosis. Among these cases, 2 patients had simple intrahepatie biliary cysts （type A dilatation）, of which one was taken operation and the other one was treated only by antibiotics. 6 patients had multiple cystic dilatations of the intrahepatic bile duets （type C）, all of which were taken PTCD. Results Patients with type A dilatation got a certain efficacy and good prognosis. All the patients with type C dilatation were taken PTCD, hut two of them underwent cystenterostomy afterwards. Now one patient had carried liver transplantation, one was waiting for liver transplatation, one was survived with portal hypertension and three others were died. Conclusions Multiple cystic dilatations of the intrahepatic bile ducts （type C） after Kasai procedure shouht be considered as severe liver damage. PTCD or cystenterostomy can only take as allevialive treatment, though PTCD could be taken before liver transplantation to decrease the jaundice. Patients with type A dilalation has a better prognosis than those with type C diatation, this may due to the slighter liver damage.

关 键 词：手术后并发症 胆道闭锁/外科学 胆管 肝内 治疗 预后 

分 类 号：R657.4[医药卫生—外科学]