腹腔镜技术在婴幼儿梗阻性黄疸诊治中的应用价值  

Application value of laparoscopic technique for the diagnosis and treatment of infants with obstructive jaundice

作　　者：奉有才 陈家蓉[1] 李画 罗树友[1] FENG Youcai;CHEN Jiarong;LI Hua;LUO Shuyou(Department of Pediatric Surgery,Maternity and Child Health Care of Guangxi Zhuang Autonomous Region,Nanning 530003,Guangxi,)

机构地区：[1]广西壮族自治区妇幼保健院小儿外科,广西南宁市530003

出　　处：《广西医学》2024年第8期1203-1207,共5页Guangxi Medical Journal

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20210094)。

摘　　要：目的探讨腹腔镜技术在婴幼儿梗阻性黄疸诊治中的应用价值。方法回顾性分析51例梗阻性黄疸婴幼儿的临床资料。所有患儿均接受腹腔镜微创探查术及胆道造影。根据检查结果,胆汁淤积症及胆管发育不良患儿均经胆囊造瘘管行胆道冲洗术,胆道闭锁患儿接受Kasai胆道重建手术。比较术前及术后1周、2周、3周、4周、2个月胆汁淤积症及胆管发育不良患儿的直接胆红素、ALT、AST水平,记录胆道闭锁患儿的黄疸消退情况。结果51例梗阻性黄疸婴幼儿中胆道闭锁17例,胆汁淤积症32例,胆管发育不良2例。胆汁淤积症患儿术后2周、3周、4周、2个月的直接胆红素、ALT水平低于术前,术后4周、2个月的AST水平低于术前(P<0.05)。2例胆管发育不良患儿术后2个月的直接胆红素、ALT、AST水平较术前有不同程度的下降。胆道闭锁患儿中有12例行Kasai胆道重建手术,术后黄疸消退满意者9例、消退不明显者3例。结论对于日龄满30 d的梗阻性黄疸婴幼儿,经内科系统保守治疗无效时,应尽早行腹腔镜胆道探查及胆道造影术,以提高诊断的准确率,并尽早治疗,以改善患儿预后。Objective To explore the application value of laparoscopic technique for the diagnosis and treatment of infants with obstructive jaundice.Methods The clinical data of 51 infants with obstructive jaundice were retrospectively analyzed.All infants received laparoscopic minimally invasive exploration and cholangiography.According to the examination results,infants with cholestasis and biliary dysplasia all underwent biliary irrigation via gallbladder fistulization tube,and children with biliary atresia received Kasai biliary reconstruction surgery.The levels of direct bilirubin,ALT,AST before surgery,and 1,2,3,4 weeks and 2 months after surgery were compared between infants with cholestasis and biliary dysplasia.Jaundice disappearance of infants with biliary atresia was recorded.Results There were 17 cases of biliary atresia,32 cases of cholestasis,and 2 cases of biliary dysplasia among 51 infants with obstructive jaundice.Infants with cholestasis obtained lower levels of direct bilirubin,ALT 2,3,4 weeks and 2 months after surgery as compared with before surgery,and a lower AST level 4 weeks and 2 months after surgery as compared with before surgery(P<0.05).After 2 months of surgery,2 infants with biliary dysplasia obtained decreased levels of direct bilirubin,ALT,and AST as compared with before surgery to varying degrees.A total of 12 infants with biliary atresia underwent Kasai biliary reconstruction surgery,and there were 9 cases of satisfactory disappearance of jaundice,and 3 cases of insignificant disappearance after surgery.Conclusion For infants with obstructive jaundice over 30 days of age,laparoscopic biliary exploration and cholangiography should be performed as soon as possible when conservative treatment by internal medicine system is ineffective,so as to elevate diagnostic accuracy,and perform treatment as soon as possible,thereby ameliorating infants′prognosis.

关 键 词：梗阻性黄疸 腹腔镜检查 胆道造影 胆道冲洗 婴幼儿 

分 类 号：R726[医药卫生—儿科]