婴儿梗阻性黄疸99mTc-EHIDA肝胆显像诊断价值和治疗探讨

目的 探讨SPECT(99mTc-EHIDA)肝胆肠道动态显像检查对婴儿梗阻性黄疸诊断及鉴别诊断的价值,并对婴儿梗阻性黄疸临床治疗方法 进行研究.方法 应用SPECT核素对24例已诊断为梗阻性黄疸的患儿进行肝胆肠道延时动态显像检查,明确临床诊断,鉴别梗阻部位和性质,并经手术及临床治疗证实,同时采取相应不同的治疗.结果 8例肝胆、肠道延时核素显像为胆汁淤滞型黄疸,其中5例因黄疸加重行经套管针胆囊内置管加压冲洗治愈,3例药物治愈.16例为先天性胆道闭锁(肝外型10例、肝内型6例)延时核素检查有肝脏显像,胆囊、肠道不显像.16例先天性胆道闭锁患儿中14例(肝外型10例、肝内型4例)行Kasai手术,术后均有胆汁排出,3例肝外型因胆瘘再次手术均病死,4例肝内型术后病死,手术后存活7例(50%).另外2例肝内型未及手术死于肝衰竭.本组患儿全部行SPECT核素检查,灵敏度为100%、特异度为66.7%、准确性为100%.结论 SPECT(99mTc-EHIDA)肝胆肠道动态显像可鉴别梗阻性黄疸的性质和部位,是安全有效的检查方法 ,有很高的诊断价值.先天性胆道闭锁患儿在适当药物治疗基础上尽早手术,术后亦应相应药物治疗.年龄小于60 d的胆汁淤滞性黄疸患儿先应以相应药物治疗2周,如胆红素升高则手术治疗.

99mTc-EHIDA hepatobiliary scintingraphy and treatment of obstructive jaundice in infants

Objective To discuss the diagnosis,differential diagnosis and treatment of obstructive jaundice in infants.Methods Infants with obstructive jaundice were examined by ECT to obtain dynamic images of the liver,biliary tract and intestine to find out the position and nature of the obstruction.Results Eight patients with delayed nuclide imagining were diagnosed as obstructive jaundice of cholestasis.Five of which with aggravated jaundice were cured by biliary irrigation and 3 by medication.For 16 patients with congenital biliary atresia,10 were exterior hepatic types and 6 interior hepatic types.They had the nuclide image of liver and biliary tract.Ten cases of the exterior hepatic types and four cases of the interior types received the Kasai operation.And bile was drained after the surgery.Seven patients survived and 4 of interior heaptic types died postoperatively.Due to bile fistula,3 patients died after the hepato-porto-jejunostomy for internal drainage.Two patients of interior hepatic types who had no operation died of the hepatic failure.Conclusion The nature and position of obstructive jaundice could be identified by nuclide imaging.Young patients with jaundice of cholestasis could be treated by antiinflamation,liver function protection,Hymecromone and Dexamethasone for two weeks.Once the serum bilirubin rises,operation would be indicated.In the case of congenital biliary atresia,operation should be done earlier on the basis of medication.