Conservative surgery for hydatid cysts of liver in children

Thirty patients below the age of 12 years were surgically treated for hydatid cysts of the liver. Twenty-two (73.3%) had a single cyst located in either hepatic lobe and eight (26.7%) harboured more than one cyst. Preoperative complications occurred in eight (26.7%) patients, which included jaundice in one, rupture in two and infection or bile staining in five. In one patient in the uncomplicated group of 22 (73.3%), left lateral hepatic segmentectomy was performed and in the rest, an endocyst was removed and an ectocyst was partially excised, with or without external tube drainage. No postoperative complications occurred in this group. However, three out of eight children with preoperative complications developed bile drainage which ceased spontaneously within 3-8 weeks. This study showed that the simple procedure of removal of an endocyst and partial ectocystectomy were suitable for the treatment of hepatic hydatid cysts in children.     

Ultrasound-guided percutaneous sclerotherapy of hydatid liver cysts in children

To evaluate the efficacy of ultrasound (US) guided percutaneous sclerotherapy in the pediatric population, 14 hydatid liver cysts (HLC) in eight male patients whose ages ranged between 6 and 16 years (mean 9.9 years) were treated. The maximum diameter was 110 mm. Albendazole was administered orally to all patients for 1 week before percutaneous treatment and for 3–6 months after the procedure to prevent dissemination of the disease. Cyst puncture was performed with 20 G Chiba needles using US guidance. More than one-half of the estimated cyst volume was aspirated, then 20% hypertonic saline (7 cysts) or sterile 96% alcohol (7 cysts) equivalent to one-third of the estimated cyst volume was injected into the cavity and left for 5–15 min. Finally, all the fluid in the cavity was reaspirated. Catheterization was not performed. Follow-up US examinations were performed every month during the first 6 months and every 3 months thereafter. The follow-up period ranged between 6 and 51 months (mean 15 months). No major complications were seen during or after the procedures. Two cysts in two patients completely disappeared. Volumes of the 11 cysts in five patients who were followed for 6–21 months were markedly reduced (22%–64% of the initial volume) and thick septations and solid debris-like structures were seen within the cyst cavities. There was no significant change in 1 cyst. US-guided percutaneous sclerotherapy is thus a safe and effective treatment of HLC in children. Accepted: 8 November 1999     

Outcome of partial internal biliary diversion for intractable pruritus in children with cholestatic liver disease

Purpose

Children with cholestatic disorders have undergone liver transplantation for intractable pruritus unresponsive to medical therapy even in the absence of liver failure. Biliary diversion procedures interrupt the entero-hepatic circulation of bile acids allowing them to be excreted in the feces thereby lowering the total bile acid pool. We evaluated the outcome of partial internal biliary diversion (PIBD) in children with intractable pruritus from inherited cholestatic disorders.

Methods

The records of children who underwent PIBD over a 4-year period were reviewed for etiology of liver disease, demographic data, preoperative and postoperative biochemical profile and improvement of pruritus. Standard statistical methods were used for analysis.

Results

Of the 12 children, 10 had progressive familial intrahepatic cholestasis (PFIC) and 2 had Alagille syndrome (AS). PIBD was done using an isolated jejunal loop as a conduit from gall bladder to mid ascending colon. Median period of follow up was 30 months. Pruritus resolved in nine children with significant reduction of serum bile acids (P < 0.02).

Conclusion

To our knowledge, this is the largest reported series of children with PIBD. PIBD is a safe, well-tolerated and effective alternative to liver transplant in children with PFIC and AS who have intractable pruritus in the absence of synthetic liver failure.     

Intrahepatic biliary cysts in biliary atresia in the era of liver transplantation

OBJECTIVES: The development of intrahepatic biliary cysts (IBC) after Kasai operation in patients with biliary atresia (BA) is recognized as an important problem; however, management strategy for IBC has not been clarified, particularly in the light of the increased use of liver transplantation. METHODS: Forty consecutive BA patients underwent hepatic portoenterostomy during 18 years from 1983 to 2000. We compared the clinical course and prognosis of the patients who developed IBC with those who did not. RESULTS: Seven of the 40 patients developed IBC. Three patients had type A (non-communicating cyst) and three patients had type C (multiple cystic dilation) IBC, and the remaining patients had type B (communicating cyst). Of the 7 patients, one patient underwent successful internal intestinal drainage, and one patient died of complications at the time of internal intestinal drainage. Three patients underwent liver transplantation due to either hepato-pulmonary syndrome (one case) or liver failure (two cases). One patient with IBC with liver failure was judged to require transplant, but was found to have pulmonary hypertension and was thus not a candidate. The remaining patient has survived without jaundice for 21 months postoperatively. Two of 21 patients with good initial bile drainage and without IBC underwent liver transplantation. The percentage of patients undergoing transplant was significantly higher in the group with IBC than in the group without IBC (P < 0.05). CONCLUSIONS: IBC was associated with worsening liver function. Previously, IBC was treated using internal/external drainage, or the patients were observed without treatment, with limited success. We now consider it reasonable to carry out liver transplantation in patients with long-standing IBC.     

Intrahepatic biliary cysts after hepatic portoenterostomy in four children with biliary atresia

We report our experience with 4 cases of cystic dilatation of intrahepatic bile ducts following hepatic portoenterostomy for biliary atresia. Two of the cases did not achieve satisfactory bile excretion and all four cases developed recurrent cholangitis after hepatic portoenterostomy. The attacks of cholangitis seemed to be associated with the presence of intrahepatic cysts. Although one case resulted in death from hepatic failure, three other cases are now outpatients. Patients who develop recurrent cholangitis following hepatic portoenterostomy, should be examined to exclude the presence of intrahepatic biliary cysts. Ultrasonography, computed tomography and percutaneous transhepatic cholangiography were all effective in detecting cysts and provided valuable information for planning treatment. Percutaneous transhepatic or surgical drainage of the bile ducts was effective in reducing jaundice, and recurrent cholangitis.     

A serious complicatıon of liver hydatid cysts in children: cystobiliary fistulas

Pediatric Surgery International - We aimed to determine predictive factors for predicting cystobiliary fistulas (CBF) in children after treatment of liver hydatid cyst (LHD). The records of...     

Kasai术后肝内胆管囊性扩张的诊治与预后

目的 总结胆管闭锁术后肝内胆管囊性扩张的诊治经验,分析其对患儿预后的影响.方法 1998年6月至2008年3月,对胆管闭锁行葛西手术的患儿进行追踪随访.通过超声检查,发现8例患儿存在肝内胆管扩张.其中3例再行MRI检查,6例再行CT平扫加增强检杳以明确诊断.此8例患儿术后均有不同程度胆管炎症状.5例行PTCD显示肝内胆管囊性扩张.3例患儿行囊肿与空肠胆支再吻合术,2例患儿仪行PTCD置管引流,2例患儿暂未予任何处理.结果 3例经手术治疗的患儿,术后黄疸消退或减轻.仅行PTCD的患儿肝内胆管扩张长期存在.结论 对反复发作的胆管炎应定期行超声检查,尽早发现肝内囊肿;对肝内胆管囊性扩张,无论其影像学分型如何,应根据其具体临床表现进行相应的积极治疗;PTCD无法长期放置,仅是暂时性的治疗,但对手术时寻找囊肿有指示作用,使手术时囊肿的定位相对容易;囊肿的大小、位置与门静脉的关系,压迫的时间、治疗是否及时有效都可影响患儿的预后.     

The clinical, radiological and surgical aspects of cerebral hydatid cysts in children

A series of 13 pediatric patients underwent surgery for cerebral hydatid cysts at the Department of Pediatric Neurosurgery between 1993 and 2003. Headache and motor weakness were the main initial signs of these patients. A round cystic lesion was the characteristic appearance on computed tomography of each patient. Different cyst locations such as the liver, kidney or spleen were detected in 5 patients. Surgery using Dowling's technique was performed in all patients as the main treatment. Intraoperative rupture and cyst recurrence were observed in only 1 patient. Subdural effusion, intraparenchymal air and hemorrhage were the main complications observed after surgery. None of the patients died after surgery. Because of its efficacy combined with excellent results, surgery is currently the method of choice in the treatment of cerebral hydatid cyst in children.     

Oxidative stress profile in the post-operative patients with biliary atresia

Background and purpose  Many post-operative patients with biliary atresia (BA) suffer from liver dysfunction, such as chronic inflammation even without jaundice after a Kasai’s hepatic portoenterostomy. Methods  The presence and degree of oxidative stress were evaluated in the post-operative patients with BA. Twelve outpatients who underwent a Kasai’s hepatic portoenterostomy were evaluated. The active oxygen products, the rate of bioantioxidant, the markers of oxidative stress, and the degree of hepatic oxidative stress were examined by immunohistochemical staining of biopsied specimens. Results  All of the oxidative stress markers in the post-operative patients with BA increased in comparison to those in the controls. Moreover, 8-OHdG immunohistochemical staining was positive in 84 ± 4.8% in hepatic cells in the portal area in the post-operative patients with BA. Conclusion  The post-operative patients with BA were under increased oxidative stress, even if their liver dysfunction was mild without jaundice. Antioxidant therapy might be necessary to decrease of oxidative stress in the post-operative patients with BA.     

胆总管囊肿根治术后胆道梗阻的原因分析和治疗策略

目的 本研究旨在分析胆总管囊肿根治术后胆道梗阻的原因, 提出相应的治疗策略.方法 回顾2006年1月至2016年1月间47例在外院接受胆总管囊肿根治术后胆道梗阻,转入我院成功行腹腔镜二次手术的患儿,对其病因进行观察,分析及治疗.结果 出现胆道梗阻症状,即反复胆管炎或持续肝功能异常距离第一次手术的时间为术后2周~10.8年(平均1.7年).在外院接受抗炎保肝利胆PTD治疗时间2周~10年(平均2.7年),未见明显好转.接受二次手术的间隔时间为1个月~11年(平均4.5年).病理显示57.4% (27/47)患儿存在I~IV级肝纤维化.本研究发现术后胆道梗阻的原因如下:①异位肝右动脉前置压迫肝管空肠吻合口近端导致梗阻占27.6% (13/47).术中将异位肝右动脉重置于肝管空肠吻合口后方解除梗阻;②初次手术未解决伴发的单一或多处肝管狭窄占29.8% (14/47).二次手术中行肝管扩大成型+肝管空肠再吻合;③吻合口狭窄占42.6% (20/47).二次手术中行肝管空肠再吻合.中位随访时间为48个月(1~120个月),无1例发生胆道再梗阻或胆管炎.肝功能于二次术后1个月~2年恢复正常.结论 异位前置肝右动脉压迫、合并单一或多处肝管狭窄、吻合技术是胆总管囊肿术后胆道梗阻的原因.应尽早外科手术解除梗阻避免肝功能损伤及肝硬化.     

Surgical treatment of pulmonary hydatid cysts in children: report of 66 cases.

AIM OF THE STUDY: Hydatid disease is a parasitic infestation which is endemic in many sheep and cattle raising areas and is still an important health problem in the world. The aim of our study was to present our surgical experience and strategy in the management of pulmonary hydatid disease. METHODS: Sixty-six patients with 83 pulmonary hydatid cysts underwent surgical treatment in our institution between January 1990 and March 2003. We used double-lumen endotracheal tubes in children older than 12 years who were operated on for hydatic cyst in the last 8 years. RESULTS: There were 38 boys and 28 girls with a mean age of 9.6 +/- 7 years (range 5-15 years). Of the 83 cysts, 61 were intact and 22 were ruptured cysts. Isolated pulmonary hydatid cyst was seen in 61 patients (92.4 %), while 5 patients (7.6 %) had combined pulmonary and hepatic cysts. Lateral thoracotomy was performed in 54 patients (82 %), thoracophrenotomy in 5, bilateral thoracotomy in 4, and median sternotomy in 3 patients. Cystotomy and capitonnage was performed in 58 cysts, cystotomy alone in 21, and resection techniques were used in 4. There were 8 postoperative complications in 7 patients. The most common complication was atelectasis. CONCLUSIONS: Surgery is the treatment of choice for most patients with pulmonary hydatid cysts. The usage of double-lumen tubes may decrease intra- and postoperative complications. Thoracophrenotomy can be chosen as the surgical procedure in the management of hepatic and pulmonary hydatid cysts.     

Hydatid cysts of the liver in children: percutaneous treatment with ultrasound follow-up

Background  

Hydatid disease is a serious public health problem in endemic areas. Percutaneous treatment is an effective alternative to surgical and medical therapy in hydatid liver disease (HLD).     

APRI评价胆道闭锁和胆汁淤积综合征肝脏纤维化程度的临床意义

目的 探讨肝功能检查和门冬氨酸氨基转移酶/血小板指数(aspartate aminotransferase-to-platelet ratio index,APRI)与肝脏纤维化程度的关系,阐述其在BA肝纤维化评估中的临床价值.方法 收集2006年2月至2011年8月间在我院治疗的胆道闭锁患儿38例和胆汁淤积综合征患儿25例为研究对象.临床观察指标包括肝功能检查,肝脏活检切片,血小板指数;肝硬化程度采用Metavir分类,APRI的诊断性评估采用ROC曲线,应用SPSS 16.0统计学软件进行统计分析.并对本组患儿进行随访,随访时间是3～69个月(平均随访时间:20.7个月).结果 胆道闭锁组患儿ALP、γ-GT、DBIL(564.14±257.75、153.36±97.47、7.55±2.57)较胆汁淤积综合征组患儿存在明显升高(P＜0.05);胆道闭锁肝硬化组患儿Age、ALT、AST、γ-GT(84.50±24.72、225.07±109.68、331.64±130.93、951.07±667.24)较非肝硬化组明显升高,两组差异具有统计学意义(P＜0.05);胆汁淤积综合征肝纤维化组患儿Age、ALT、AST(84.76±14.28、159.92±61.76、238.15±62.60)较非肝纤维化组(54.17±11.17、98.92±58.08、151.17±41.44)明显升高,两组差异具有统计学意义(P＜0.05).患儿绘制APRI的ROC曲线,用于判定肝硬化程度,胆道闭锁组敏感性为79％,特异性为88％;胆汁淤积综合征组敏感性为91％,特异性为79％.胆道闭锁中肝硬化组病死率显著高于非肝硬化组,且自体肝生存情况低于非肝硬化组.结论 肝功能检查可以作为胆道闭锁的初步判断指标,绘制APRI的ROC曲线对于评价胆道闭锁及胆汁淤积综合征患儿的肝脏纤维化情况均有较高准确性和可靠性,可用于预测预后和提早做好肝移植准备,因其简单、无创性可以在临床上广泛应用.     

Evaluation of catch-up growth after liver transplantation in children with biliary atresia

Orthotopic liver transplantation (Tx) has improved survival in infants with extrahepatic biliary atresia (BA) when portoenteroanastomosis fails. Symptoms leading to Tx include liver failure, poor quality of life and growth failure. The objective of the study was to determine catch-up growth in children with BA. Medical records and growth data of 36 patients (24 girls) who received a Tx due to BA were analyzed. Thirty-two patients completed 3 yr and 15 patients 7 yr of follow-up after Tx. At Tx, the median age was 2.7 yr (range 0.7-12.6) and mean height Z score (+/-s.d.) was -1.56 (+/-1.3). Patients were divided in two groups according to age at Tx: group I (n = 10), younger than 1.0 yr, and group II (n = 26) older than 1.0 yr. Median age (range) at Tx in group I was 0.8 yr (0.7-1.0) and in group II it was 3.35 yr (1.25-12.6). Thirteen patients (nine in group I) were receptors of living related donors. We evaluated linear growth, liver and renal function, immunosuppressive regimen and allograft rejection episodes. We did not find any significant differences in allograft or renal function, immunosuppressive therapy and number of acute rejection episodes or height Z score at Tx, second and third year post-Tx between both groups. The mean height Z score at Tx in group I was -1.61 and in group II -1.54; at the second year, group I -0.66 and group II -1.08; at the third year, group I -0.17 and group II -0.85; and at the seventh year (total group) -0.3. However, the height gain at the third year was better in group I than in group II (p < 0.01, t-test). Height Z score at the third year improved more than 1 SDS in seven out of eight patients in group I and in only nine out of 24 in group II (odds ratio 11.6). We also found a correlation between height gain at the third year and age at Tx (r-0.65) and between height gain at the third year and height Z score at Tx (r-0.54) (Pearson, p < 0.05). Children with BA who are transplanted before 12 months of age presented better catch-up growth without change survival and morbidity. Orthotopic liver Tx improves survival and also enables height gain in these children.     

�������ڶ�ͯ�ε�������Ӧ��

??Probiotics are live??nonpathogenic bacteria with the function of improving the micro-environment and promoting the health of the host. The "gut-liver axis" shows that there is complexed relationship between the liver/gallbaldder and gut microbiota. Alterations of the type and amount of the micro-organisms in the intestinal tract can result in liver dysfunction due to the production of ammonia and endotoxin. Some studies have confirmed the positive influence of probiotic strains on the prevention and treatment of liver and biliary diseases in children??such as nonalcoholic fatty liver disease??cholestasis??cirrhosis??and liver transplantation. Probiotic therapy??as a safe??inexpensive and noninvasive treatment strategy??can alleviate and improve the pathophysiological courses and symptoms of different types of liver and biliary diseases without obvious side effects??which has great prospect of application .