胆道闭锁以晚发性维生素K缺乏性颅内出血为首发症状的临床诊疗体会  

The clinical experience of diagnosis and treatment of late vitamin K deficiency intracranial hemorrhage as the first symptom of biliary atresia

作　　者：魏中南[1] 詹江华[1] 张庆江[1] 马骁[1] 孙宁[1] 蔡春泉[1] 

机构地区：[1]天津市儿童医院外科,300074

出　　处：《天津医药》2016年第7期814-816,共3页Tianjin Medical Journal

基　　金：国家自然科学基金资助项目(81570471);天津市卫生行业重点攻关项目(14KG129);天津市卫生局科技基金资助项目(2014KR09)

摘　　要：目的探讨因胆道闭锁导致晚发性维生素K缺乏性颅内出血的外科诊疗体会。方法收集天津市儿童医院神经外科于2000年1月—2013年12月诊疗的6例因胆道闭锁导致晚发性维生素K缺乏性颅内出血患儿的临床资料,分析在治疗颅内出血过程中,对于同时存在黄疸延迟消退的患儿,如何鉴别并尽早发现胆道闭锁的存在。结果 6例患儿中,男1例,女5例,平均初诊年龄为(16.0±2.6)d,在神经外科住院治疗期间行钻颅血肿外引流术及输液治疗,治疗过程中患儿黄疸加重,怀疑存在胆道闭锁,经普外科医师会诊,在平均年龄(29.1±1.2)d时转至普外科做进一步治疗,并确诊为胆道闭锁。结论小儿神经外科医师应对胆道闭锁导致的维生素K吸收不足引发的颅内出血有充分的认识,进行早期诊断,避免延误胆道闭锁治疗的最佳时间。Objective To investigate the surgical diagnosis and treatment of late vitamin K deficiency intracranial hemorrhage caused by biliary atresia. Methods Clinical data of six cases of biliary atresia with late vitamin K deficiency intracranial hemorrhage were collected in the Department of Neurosurgery of Tianjin Children’s Hospital from January 2000 to December 2013. Data were analyzed to identify the biliary atresia as soon as possible in the treatment of intracranial hemorrhage and prolonged jaundice in children. Results Six cases (1 male, 5 female), mean age was (16.0±2.6) days, and were treated with external drainage of intracranial hematoma and infusion therapy. In the treatment, children were found jaundice exacerbation and doubted about biliary atresia. After consultation by general surgeons, children were transferred to the department of general surgery for further treatment at an average age of (29.1±1.2) days, and were diagnosed as biliary atresia by intraoperative cholangiography. Conclusion Pediatric neurosurgeon should have a sufficient understanding and make an early diagnosis to late vitamin K deficiency intracranial hemorrhage caused by biliary atresia, to avoid delaying the optimal treatment time of biliary atresia.

关 键 词：胆道闭锁 维生素K缺乏 颅内出血 

分 类 号：R726[医药卫生—儿科]