产前诊断先天性胆总管囊肿37例临床分析  

Clinical analysis of prenatal diagnosis of choledochal cyst in 37 infants

作　　者：胡吉梦[1] 刘青[1] 吴晔明[1] 周莹[1] 王俊[1] 潘伟华[1] 

机构地区：[1]上海交通大学医学院附属新华医院儿外科,上海200092

出　　处：《临床儿科杂志》2013年第9期858-861,共4页Journal of Clinical Pediatrics

摘　　要：目的探讨产前诊断先天性胆总管囊肿患儿的临床治疗。方法将2006年9月至2013年2月收治的产前诊断为先天性胆总管囊肿患儿37例，按手术时年龄分为A组（0-3个月，20例）和B组（〉3个月，17例），回顾性分析两组患儿的临床特点、手术前后肝功能指标、术后并发症及肝脏组织病理检查结果等。结果A组5例患儿出生后有黄疸，B组2例黄疸；两组丙氨酸转氨酶（ALT）和天门冬氨酸转氨酶（AST）差异无统计学意义（P均〉0．05），A组手术前、后总胆红素（TBIL）和直接胆红素（DBIL）水平高于B组，差异有统计学意义（P均〈0．05）；A组2例出现吻合口狭窄，1例胆漏，B组无术后并发症。肝脏活检提示胆汁性肝硬化改变11例，其中A组4例（36．36％），B组7例（63．64％），但两组肝硬化发生率差异无统计学意义（P=0．160）。结论对产前诊断为先天性胆总管囊肿患儿，应密切观察，发现黄疸、白便、ALT和AST升高明显、超声提示囊肿短期增大明显者应尽决手术治疗，以减轻肝功能损害，减少肝硬化发生。Objectives To explore the clinical intervention of prenatal diagnosed congenital choledochal cyst in infants. Methods 37 infants with prenatally diagnosed congenital choledochal cyst from September 2006 to February 2013 were di- vided into early （0-3 month） operation group （Group A, n=20） and late （〉3 month） operation group （Group 13, n=17） according to the timing of surgery. The clinical characteristics, the preoperative and postoperative liver function, postoperative com- plications and pathological examination of liver biopsy were retrospectively analyzed. Results Five infants in group A and 2 infants in group B became jaundiced after birth. No statistical difference was found in alanine aminotransferase （ALT） and aspartate aminotransferase （AST） between two groups （P〉0.05）. Preoperative and postoperative levels of total bilirubin （TBIL） and direct bilirubin （DBIL） in group A were significantly higher than those in group B （P〈0.05）. Two cases had anastomotic stricture and one case had bile leakage in group A while no postoperative complication was found in group B. Liver biopsy re- suits showed that there were 11 cases of biliary cirrhosis, including 4 cases in group A （36.36%） and 7 cases （63.64%） in group B, but no statistical difference in incidence of cirrhosis between two groups （P=0.160）. Conclusions Infants with prenatally diagnosed congenital choledochal cyst should be closely observed. Once jaundice, clay-coledstool, increased ALT and AST, fast growing enlarged cysts were found, infants should be surgically treated as soon as possible to reduce liver damage and theincidence of liver cirrhosis.

关 键 词：胆总管囊肿 产前诊断 治疗 

分 类 号：R726.5[医药卫生—儿科]