婴儿梗阻性黄疸诊断与治疗探讨

目的：探讨ECT对婴儿梗阻性黄疸诊断、及鉴别诊断的价值，对临床治疗方法进行评价。方法：应用ECT核素对22例己诊断为梗阻部位和性质。结果：8例胆道延时，核素显像为胆汁淤滞型阻塞型黄疸。其中5例因黄疸加重行经套针胆囊内置管加压冲洗治愈，3例药物治愈。14例为先天性胆道闭锁（肝外型8例、肝内型6例），有肝胆显像，但肠道不显像。其中12例（肝外型8例、肝内型4例）行Kasai手术，术后均有胆汁排出，4例术后死亡，3例因胆瘘再次行肝门空肠吻合术均死亡，手术后存活5例（35%）。另外2例未及手术者死于肝衰竭。结论：ECT核素延迟显像可鉴别梗阻性黄疸的性质和部位。年龄小于60d的胆汁淤滞性黄疸患儿先应以药物抗感染、保肝、中药、利胆素及地塞米松适量应用治疗2周，如胆红素升高则手术治疗。先天性胆道闭锁患儿应在适当药物治疗尽早手术。

Diagnosis and Treatment of Obstructive Jaundice in Infants

Objective:To discuss the diagnosis,differential diagnosis and treatment of obstructive jaundice in infants Me thods: Infants with obstructive jaundice were examined by ECT dynamic images the liver,biliary tract and intestine to find out the position and nature of the obstruction.Results:Cholestasis type was found in 8 patients by delayed nuclide imaging.Five patients with aggravated jaundice were cured by biliary irrigation,three patients were cured by medicine.Bile was drained in 10 after Kasai procedure,3 of them later underwent hepato-porto-jejunostomy for internal drainage because of bile fistula,they died postoperatively.In two patients nothing could be done except liver biopsy.Five patients surived postopertively(35%).Conclusion:The cause and nature of obstructive jaundice could be identified by nuclide imaging.Young patients with jaundice of cholestasis could be treated by antiinflammation,liver function protection,Hymecromone and Dexamethasone,should serum bilirubin be high,operation would be indicated.In case of congenital biliary atresia,operation should be done early after medicine treatment.