胆道闭锁诊治体会

目的　分析胆道闭锁诊断、治疗及预后情况 ,探讨胆道闭锁的早期诊断和治疗策略。方法　回顾性分析我院近 5年收治的 2 8例胆道闭锁患儿诊断手段、手术年龄、手术方式及术后生存率。结果　胆道闭锁早期诊断率为 1 4 % (4 / 2 8) ,手术时年龄 1 3～ 2 70d ,6 0d以内 4例 (1 4 % ) ;6 1～ 90d 1 3例 (4 6 % ) ;91～ 1 2 0d 8例 (2 9% ) ;1 2 0d以上 3例 (1 1 % )。没有患儿接受肝移植 ,1～ 5年生存率为35 % (9/ 2 5 )。结论　密切观察临床表现、掌握胆道闭锁的影像学特点和及时采用腹腔镜探查可提高胆道闭锁的早期诊断率。完善手术方式、让更多的患儿接受肝移植、开辟新的治疗方法如抑制肝胆管细胞凋亡、抗体及基因治疗可提高胆道闭锁的长期治愈率

Diagnosis and treatment for biliary atresia

Objective To investigate the diagnosis, treatment and postoperative outcome of biliary atresia, and discuss early diagnosis and new medical strategies of treatment.Methods The diagnosis, operative age, surgical procedures and postoperative survival rate of 28 children in our hospital with biliary atresia were reviewed retrospectively.Results The early diagnostic rate of biliary atresia was 14%. Operative age was from 13 to 270 days and that of 4 (14%) children was <60 days, There were 13 children with age ranging from 61 to 90 days (46%), 8 from 91 to 120 days (29%) and 3>120 days (11%). No child with biliary atresia received liver transplantation. The 1 5 survival rate was 35% (9/25).Conclusion Lower early diagnostic rates were the main causes of lower survival rates. Close observation of clinical presentations and imaging features of children with biliary atresia and exploration under laparoscopy in time can enhance the early diagnostic rates of patients with biliary atresia. The long term survival rates can be increased through those methods such as modifying surgical procedures, more biliary atresia children with advanced disease accepting liver transplantation and developing new medical strategies for treating patients with biliary atresia.