胆总管未闭锁型胆道闭锁的手术治疗及疗效分析

目的 分析24例胆总管未闭锁型胆道闭锁的临床疗效,旨在指导临床对此类胆道闭锁的手术方式进行选择.方法 回顾分析我院1995至2006年间收治的24例胆总管未闭锁型胆道闭锁患儿手术、术后病理及随访资料.对空肠肝门吻合(A组)与胆囊肝门吻合(B组)在自体肝生存率、黄疸清除率、反流性胆管炎发生率及临床疗效等方面比较分析;并对胆道闭锁胆囊病理标本及正常对照组胆囊进行胶原纤维Van Gieson染色和CD68免疫组化染色,比较其纤维化及炎性反应的差异.结果 平均(51±29.02)个月随访期内,自体肝生存率为66.7%.A组自体肝1年生存率为78.6%,3年生存率78.6%;B组1年生存率为66.7%,3年生存率33.2%,两组3年生存率差异有统计学意义(P＜0.05);A组术后6个月黄疸清除率明显高于B组(86.7%比33.3%,P＜0.05);术后1年胆管炎发生率,A组为60.0%,B组为44.4%(P＞0.05).胆道闭锁患儿胆囊表现为明显纤维化和CD68阳性细胞浸润.结论 胆囊肝门吻合治疗胆总管未闭锁型胆道闭锁的疗效较肝门空肠吻合差,可能与胆囊肝门吻合后残余胆道存在纤维化及炎症细胞浸润有关,对其治疗推荐采用肝门空肠吻合.

Effect of surgical treatment of biliary atresia with patent common bile duct

Objective To evaluate the effects of Kasai procedure and hepatic portocholecytostomy(HPC)in the treatment of biliary atresia with patent common bile duet.Methods We reviewed 24 pattents wlth billary atresm with patent common bile duct who underwent operations between 1995 and 2006.Among them,19 were males,and 5 were females.Age at operation ranged from 43 to 120 days,average was 76.27±20.36 days.The patients were divided into two groups:grouP A of 15 patients were performed Kasai procedure,while group B of 9 patients underwent hepatic portocholecytostomy(HPC). We compared the rates of jaundice clearance,survival rates of the native liver,cholangitis occurrence and clinical results between the two groups.Meanwhile,removed pathologic spectmens were collected to compare with norrnal gallbladders tissue in the field of fibrosis severity by Van-Gieson staining and CD68 expression by immunohistochemical staining.Image-analysis technology was used to quantitatively analyze the results.Results Six months after operation,the rate of jaundice clearance was 86.7%in group A,while 33.3%in group B(P＜0.05).Occurrence of cholangitis in group A was 60.0%,44.4%in group B(P＞0.05).One-year survival rates of two groups were 78.6%and 66.7%(P＞0.05),while three-year survival rates of two groups、were 78.57%and 33.3%respectively(P＜0.05).There was no difference in one-year cholangitis occurrence between group A(60.0%)and group B(44.4 %).The fibrosis and CD68+cell infiltration were more severe in biliary atresta than those in normal control(P＜0.05).Conclusions The effect of hepatic portocholecytostomy(HPC)was worse than that of Kasai procedure in biliary atresia with patent comlnon bile duct,and it may be associate with bile duct fibrosis and inflammation.