I型胆管闭锁的外科治疗

目的探讨I型胆管闭锁的外科治疗以及临床意义。方法2003—2011年，作者收治胆道闭锁患儿98例，其中伴有胆总管闭锁的I型胆管闭锁患儿5例，男3例，女2例，年龄62～127d。行胆囊-空肠吻合术2例，肝管-空肠吻合术3例。结果2例胆囊-空肠吻合术患儿退黄时间分别为术后10d和术后17d（退黄标准为总胆红素〈20μmol／L）；3例肝管-空肠吻合术患儿退黄时间分别为术后20d、1个月和2个月（退黄标准同前）。术后随访时间1—5年；2例胆囊-空肠吻合术患儿术后未见黄疸反复。3例肝管-空肠胆道重建手术患儿中，1例术后未见黄疸反复，1例术后5个月出现黄疸，诊断为胆管炎，经抗炎治疗后好转；1例反复发作胆管炎最终选择肝移植。结论术中胆道造影是诊断胆道闭锁的金标准；如果术中造影证实为胆总管闭锁，且胆囊与左、右肝管通畅，主张采取胆囊-空肠吻合术。肝管-空肠吻合容易造成吻合口狭窄；过度解剖肝门对于术后恢复不利。

The Surgical treatment in the type I biliary atresia

Objective The retrospective study reviews the surgery and clinical significant of type I bili- ary atresia. Methods From 2003 till to 2011, there are 98 patients with biliary atresia received treatment in the Tianjin Children＇ s Hospital, including 5 cases （ 3 boys and 2 girls） with type I, underwent corrective sur- gery. Two patients received Choleeystojejunostomy, .the others received Kasai portoenterostomy. Results The ages of the patients ranged from 62 to 127 days, there are 3 boys and 2 girls, total 5 patients in this group. Two patients received Cholecystojejunostomy, the time of clear their jaundice at the 10days and 17 days after the surgery （Jaundice free standard is TBIL 〈 20 i.tJnol/L）. Three patients received Kasai portoenterostomy, the time of clear their jaundice at the 20 days, 1 month and 2 months after surgery. There is no recurrent jaundice after Cholecystojejunostomy alive with their native liver at a fellow-up 9 months and 4 years. In the other group, one case alive with his native liver, the other has one time recurrent jaundice or postoperative cholangitis after surgery, and recovers after received the anti - inflammatory; the last one with postoperative cholangitis, failure of the procedure leaves the liver transplantation. Conclusions The gold standard for the diagnosis of biliary atresia was intraoperative cholangiography. If we testified through introperative cholangiography the atresia loca- ted in the common bile duct, and the patency of the gallbladder and the common hepatic ducts. We suggested doing Cholecystojejunostomy, it can dilated the anastomotie size. Occasionally, dissection in the hepatic ducts easy to damage the hepatic artery, it can reduce the blood support to the bile ducts. So, over dissedtion is bad for the recovery of the child with biliary atresia.