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.

Diagnosis and treatment of intrahepatic biliary cysts in children with biliary atresia after portoenterostomy

Objective To summarize the experience of diagnosis and treatment of intrahepatic biliary cysts(IBCs)in children with biliary atresia after portoenterostomy in order to analyze the influence of IBCs on the prognosis of patients with biliary atresia(BA).Methods The patients with BA who underwent portoenterostomy were followed up from June 1998 to March 2008.Ultrasonography showed cystic dilatation of intrahepatic biliary system in 8 cases.In the abovementioned cases,three were diagnosed by MRI and six by CT enhancement scanning.All the patients had symptoms of cholangitis postoperatively.Five of them who underwent PTCD and 3 underwent operation of cysticjejunum anastomosis.Results Jaundice disappeared or alleviated in the 3 patients who underwent a second operation.The patient only accepted biliary drainage by FTCD had persistent intrahepatic biliary cyst.Conclusions Regular ultrasonography examination is needed in patients with recurrent cholangitis so as to get the IBCs diagnosed in time.Once the existence of IBCs is proved by imaging examination,active treatment should be adopted immediately according to patients' clinical manifestations.PTCD can not be kept for a long time,as its function is temporary biliary drainage.Cystic-jejunum anastomosis is an effective operation for patients with IECs after Kasars operation.