彩色多普勒超声对婴儿外科性黄疸的诊断价值

目的在婴儿期有多种引起黄疸的肝胆外科疾病,本研究通过术前对胆道闭锁、先天性胆总管囊肿等疾病声像图形态特点及血供的观察,探讨彩色多普勒超声显像在婴儿外科性黄疸鉴别诊断中的应用价值.方法二维超声观察肝脏、胆囊及胆管的形态大小,彩色多普勒超声观察门静脉及肝动脉的血流并鉴别肝动脉及胆管结构.结果手术治疗胆道闭锁20例,超声术前诊断18例;先天性胆总管囊肿16例,超声术前诊断16例.胆道闭锁术前超声显示肝脏肿大,胆囊细小且壁增厚,肝门部三角形高回声块,门静脉流速减慢,肝动脉流速增快,阻力指数增大.先天性胆总管囊肿超声显示胆总管部位囊性包块.结论彩色多普勒超声对婴儿外科性黄疸常见病因的早期诊断、鉴别诊断与指导治疗均有重要的应用价值.     

Antenatal diagnosis of a choledochal cyst. Case management and literature review

Antenatal abdomino-pelvic ultrasound done on a 36-year-old woman at 19 weeks' gestation revealed a subhepatic cyst in the foetus. Postnatally, a type I choledochal cyst was confirmed in the newborn female infant. Biliary obstruction necessitated cyst excision and hepaticojejunostomy at age 16 days. We recommend early surgical intervention for neonates with choledochal cysts manifesting objective evidence of biliary obstruction. Non-obstructed patients are best explored later (> three months of age) when the risk of iatrogenic injury to the biliary tree and hepatic vessels is reduced.     

Surgical procedures for choledochal cysts

The case of a 27-year-old man who became symptomatic for a choledochal cyst at the age of 6 months is presented. Treatment of this patient mirrored the major surgical procedures recommended in the literature over the patient's lifetime. The surgical procedure that seems to be curative is excision of the cyst with Roux-Y hepaticojejunostomy. This procedure eliminates the major complications of this disease, which are biliary obstruction, ascending cholangitis, biliary cirrhosis, malignant degeneration, and, occasionally--as in this patient--erosive ulceration with bleeding.     

先天性胆总管囊肿的腹腔镜治疗进展

目前腹腔镜下胆总管囊肿切除、肝总管空肠Roux-en-Y吻合胆管重建术已成为治疗先天性胆总管扩张症的先进术式。国内外一些学者已经开展了腹腔镜下胆总管囊肿切除术,研究结果表明,该术式是一种安全有效的治疗方法,具有创伤小,瘢痕不明显,术中显露清晰,术后恢复快,住院时间短及很好的远期效果等优点。     

先天性胆总管囊肿患儿血清酶学测定

目的 了解胆总管囊肿对肝脏功能的影响。方法 对２５例胆总管囊肿患儿进行术前、术后检测各种血清酶（ＡＬＰ、ＧＧＴ、ＡＬＴ、ＡＳＴ、ＡｃｈＥ、ＭＡＯ等）以及肌酐，胆固醇等反映肝脏功能的指标。并进行术前、术后分级比较。结果 黄疸组的ＡＬＰ、ＧＧＴ，ＡＳＴ，ＡＬＴ均明显高于无黄疸组（Ｐ〈０．００５）。而且术后明显低于术前。肝纤维组织增生组ＭＡＯ无明显增高。ＡｃｈＥ、肌酐、总蛋白、胆固醇等几项指标均在正常参     

小儿胆道重建术后逆行感染预防方法的探讨

目的　探讨在先天性胆总管囊肿标准术式即囊肿切除胆道重建的基础上 ,采用延长胆支空肠袢的方式预防重建胆道逆行感染。方法　回顾性分析 1989年～ 2 0 0 3年 3 5例接受采用延长胆支空肠袢的方法行根治性囊肿切除肝总管与肠Roux -Y吻合术治疗先天性胆总管囊肿患儿的临床资料。结果　 3 5例均采用延长胆支空肠袢的方法行根治性囊肿切除 ,肝总管与腔肠Roux -Y吻合术 ,达到了预防胆道逆行感染的目的。结论　采用延长胆支空肠袢的方法行根治性囊肿切除肝总管与空肠Roux -Y吻合术是预防先天性胆总管囊肿术后胆道逆行感染的一种有效手术方式。     

先天性胆总管囊肿诊治探讨

目的：探讨先天性胆总管囊肿的临床特点，选择合适的手术治疗方式。方法：对46例先天性胆总管囊肿的临床资料进行回顾性分析。结果：46例病人中，41例行囊肿切除、肝管空肠鲁氏Y形吻合，2例因严重粘连出血而行囊肿空肠吻合，2例囊肿巨大，伴有严重感染者先期行外引流术，待一般情况好转后二次行根治性手术。1例因重症胆管炎行外引流。结论：对囊肿伴严重感染者先期行外引流术可有效控制感染。囊肿全切除、肝管空肠鲁氏Y形吻合应作为胆总管囊肿的首选术式。完整的囊肿切除、胆肠吻合口应尽可能地大，保证胆肠黏膜对黏膜的完整吻合。     

Technical points of total laparoscopic choledochal cyst excision

Background  Choledochal cyst excision and biliary enteric reconstruction constitute the best therapy for choledochal cyst. And laparoscopy is currently used to cure this disease now.

Methods  We retrospectively analyzed the clinical data of 34 cases of total laparoscopic choledochal cyst excision between January 2007 and August 2011. All patients underwent in vitro Roux-en-Y hepatoenterostomy.

Results  All 34 patients underwent successful total laparoscopic choledochal cyst excision. The operation time was 200–360 minutes. The duration of hospital stay was 3–7 days. Follow-up observations lasted 1–56 months. One patient developed an anastomotic stoma stricture, but no other cases had postoperative complications. No patients died.

Conclusion  Total laparoscopic choledochal cyst excision is safe and feasible.

     

小儿先天性胆总管囊肿合并严重感染的治疗体会

目的 寻找治疗小儿先天性胆总管囊肿合并严重感染的最佳治疗方法，以减少术后并发症，提高治愈率和生活质量。方法 对16例小儿先天性胆总管囊肿合并严重感染采取的不同治疗方法进行回顾性临床分析，探讨不同的治疗方式对其预后的重要性。结果 本组中9例先行囊肿外引流术，再行囊肿切除、胆道重建术，均治愈；3例I期囊肿切除、胆道重建术，其中2例死亡，1例反复出理胆管炎；4例行囊肿空肠吻合术，其中3例需要再次手术。结论 对于小儿先天性胆总管囊肿合并严重感染比较好的手术方法为先行囊肿外引流术，Ⅱ期再行囊肿切除、胆道重建术。     

小儿胆道闭锁症诊断与处理的改进

回顾了4年来18例胆道闭锁症的诊断与处理。指出以十二指肠引流液胆红素及胆酸测定鉴别胆道闭锁症与新生儿肝炎简便易行,可以缩短术前诊断时间。术中使用稀释美兰胆道造影代替X线胆道造影也可以了解肝外胆道的形态。作葛西手术时适当切断肝脏冠状和镰状韧带托出肝脏,在腹腔外解剖肝门可以降低手术的难度,便于完成肝门肠吻合操作。     

Surgical treatment of congenital choledochal cyst

20 cases of congenital choledochal cyst were operated by modified Lilly's method from 1980 to November 1985 in our Hospital. There were 4 males and 16 females. Their ages ranged from 50 days to 15 years with a mean of 5.1 years. All patients had preoperative ultrasonographic examination, barium meal radiography of the gastrointestinal tract or percutaneous transhepatic cholangiography. All had choledochal cystectomy with retention of the outer layer of the posterior wall of the cyst. We modified Lilly's method by injecting normal saline between the outer and inner layer of the choledochal cyst so that the outer layer could be isolated. Reconstruction of the biliary tract was then performed. 2 patients had choledochoduodenostomy and 18 patients had hepaticojejunostomy (1 end to end and 17 end to side). 19 patients had also had cholecystectomy. The post-operative course of the operation was found to be smooth and safe. Patients were followed up for a period from 6 months to 7 years. 3 patients had cirrhosis of liver, 2 of whom died within 8 months. The mortality rate in our series was 10%. The operative treatment and the problems of biliary reconstruction are discussed.     

Screening for biliary atresia

Biliary atresia is a severe progressive cholangiopathy which leads to early liver cirrhosis and is uniformly fatal. Early surgical intervention (the Kasai procedure) is needed for an improved outcome. However, early recognition and diagnosis is not easy during the neonatal period because of the high incidence of neonatal jaundice, ill-informed and less than urgent appraisal of the clinical manifestations among jaundiced neonates. A mass screening program for biliary atresia using a stool color card was conducted in Taiwan from March 2002 (in 49 hospitals and clinics) to December 2003 (in 95 hospitals and clinics). The stool color card for infants has proved to be a sensitive and specific screening method for biliary atresia in infants younger than two months of age.     

腹腔镜胆总管囊肿切除术(附48例报告)

目的:总结腹腔镜下胆总管囊肿切除、胆道重建手术治疗先天性胆总管囊肿的经验.讨论术中及术后的治疗问题.方法:回顾2001年8月至2003年10月间经腹腔镜行胆道造影、胆囊切除、囊肿切除,探查肝管,肝管空肠Roux-en-Y吻合 防返流瓣手术48例,并对手术方法和手术目的进行分析.结果:48例中腹腔镜下顺利完成44例(91.7%),2例因以前手术,肠粘连严重,中转开腹手术.另2例因囊肿过大,腹腔镜探查操作困难,中转开腹手术.术后并发症4例(8.3%),2例粘连性肠梗阻,再次手术.另2例吻合口漏,再次手术重新吻合.结论:腹腔镜下完成胆总管囊肿切除,肝管空肠Roux-en-Y吻合术.手术创伤小,出血少,恢复快.     

ERCP对成人先天性胆管囊肿的诊断及治疗价值

目的:评价经内镜逆行胰胆管造影(ERCP)对成人先天性胆管囊肿诊断和治疗的价值。方法:ERCP检查24例成人先天性胆管囊肿,并对其中11例合并梗阻性黄疸和化脓性胆管炎的病人及时行内镜下鼻胆引流术(ENBD)治疗。结果:按Todani的分类标准,ERCP检查发现Ⅰ型胆管囊肿14例(58.3%)、Ⅳa型8例(33.3%)、Ⅴ型即Caroli’s病2例(8.3%),其中包括囊肿癌变3例,胰胆管合流异常(APBDJ)4例。ERCP对胆管狭窄范围的判断及APBDJ的诊断优于CT及B超。ERCP治疗10例,包括胆管结石4例,胆管狭窄2例,胆管炎2例,囊肿癌变2例。ERCP治疗后1周内病人血白细胞计数、总胆红素、丙氨酸氨基转移酶、碱性磷酸酶明显下降。结论:成人先天性胆管囊肿Ⅰ型最为常见,胆管囊肿癌变率高、易合并相关的肝胆系统疾病。ERCP对胆管囊肿及APBDJ的诊断和分类较B超和常规CT检查更为直观、准确。ENBD治疗可迅速缓解梗阻性黄疸和化脓性胆管炎病人的症状,为进一步手术治疗创造良好的条件。     

先天性胆总管囊肿的诊治

目的探对先天性胆总管囊肿的诊治及疗效.方法22例先天性胆总管囊肿中,14例行胆总管囊肿切除,肝总管空肠Roux-en-Y吻合术;8例行囊肿切除术间置空肠代胆道加矩形瓣术.结果22例患者均治愈出院,无1例死亡.术后随访18例,随访时间1.5-9.5年,平均4.5年,优良率为90%.结论胆总管囊肿切除,肝管空肠Roux-en-Y吻合与间置空肠代胆道加矩形瓣抗返流术是先天性胆总管囊肿切除后胆道重建适宜选用的手术.     

新生儿消化道常见畸形治疗进展

新生儿先天性畸形是婴儿死亡的重要原因之一。新生儿消化道畸形的发生率在新生儿先天性畸型中居第三位,常需进行手术治疗。该文介绍了食道闭锁、先天性幽门肥厚狭窄、小肠闭锁、先天性巨结肠及胆道闭锁等畸形手术治疗的进展。     

危重型胆总管囊肿的诊治体会

目的 提高对危重型胆总管囊肿的诊治水平,方法 对收治的２３例危重型胆总管囊肿患儿进行回顾性分析总结,结果 ２３例中３岁以下婴幼儿占２０例（８６．９５％）均为囊肿型,有囊肿破裂腹膜为炎５例,囊肿直径超过１０ｃｍ１７例,死亡５例（２１．７％）,２３例中行囊肿外引流术７例（死亡１例,行Ⅱ期手术治愈６例）囊肿内引流术１３例（死亡２例）囊肿切除胆道重建术３例（死亡２例）结论 危重型胆总管囊肿具有起病急,病情     

先天性胆管囊肿研究进展

先天性胆管囊肿,亦称先天性胆管囊状扩张症,该病具有分型复杂、症状无特异性、手术难度大、并发症多等特点。因该病临床症状不典型,且常合并肝、胆、胰疾病,极易被误诊或者漏诊,严重威胁患者生命、健康。随临床诊疗技术的不断更新,该病在病理、形态、病因、诊断及治疗方面均有所发展,该综述通过其病因、分型着手,对近年来先天性胆管囊肿的诊断、治疗方面内容进行综述。     

儿童胰腺炎的内镜治疗

作者报道了3例接受胰腺炎内镜逆行胆胰管造影（ERCP）治疗的患儿。第1例患儿有家族性的胰腺炎病史，接受了括约肌切开术和结石去除术。第2例患儿是继发于胰腺分裂的胰腺炎，接受了括约肌切开术和stunt of small caroncula。第3例患儿表现为伴有假性胰腺囊肿的严重胰腺炎，引流后接受了括约肌切开术、Wirsung扩张术和结石去除术。ERCP是一种有效的治疗方法，可作为复杂胰腺炎外科治疗的选择方法。     

加速康复外科理念在儿童先天性胆总管囊肿治疗中的应用

目的: 探讨加速康复外科（ERAS）理念应用于儿童先天性胆总管囊肿围手术期管理中的可行性。方法: 将浙江大学医学院附属儿童医院2017年6月至2019年6月收治的先天性胆总管囊肿患儿设为队列目标人群,按入院顺序纳入ERAS组和对照组,各65例。分别在术前准备、术中麻醉管理、术后管理三个阶段观察ERAS组和对照组术中肠道情况、手术所需时间、术后差异操作结果、术后开始进食时间、术后腹腔引流液、术后住院时间、住院总费用、术后并发症等情况。结果: 与对照组比较,ERAS组术中肠道情况满意度,术后胃肠功能恢复时间、腹腔引流液量少于50 mL所需时间、腹腔引流管拔除时间和住院时长均有所改善（P < 0.05或P < 0.01）;ERAS组拔除腹腔引流管后腹腔积液量多（P < 0.01）,但术后浮肿发生率低（P < 0.05）;两组家长满意度相近（P>0.05）,但ERAS组家长配合度提高（P < 0.05）,住院总费用降低（P < 0.01）。结论: ERAS理念应用于儿童先天性胆总管囊肿临床治疗具有一定的优势。