胆道闭锁术中胆汁流量及胆汁成分的观察分析

目的 探讨胆道闭锁术中胆汁流量及成分变化与预后的关系.方法 本组对27例BA患儿行Kasai手术时,采用5 ml气体采样管收集和测量从肝门流出的胆汁.以17例胆总管囊肿患儿术中收集的胆汁作为对照组,其中测胆汁流量者7例.采用全自动生化仪检测胆汁中磷脂、总蛋白(TP)、胆汁酸(TBA)、总胆红素(TBIL)、直接胆红素(DBIL)、总胆固醇(TC)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、谷氨酰胺转肽酶(GGT)、碱性磷酸酶(ALP)的浓度.术后随访1～6个月,随访内容有黄疸消退时间、术后血生化、术后胆管炎发生情况.结果 BA组胆汁流量显著低于对照组(P<0.05).手术日龄>60 d的BA患儿及术前血ALT>150 U/L的BA患儿术中胆汁流量均显著低于对照组(P<0.05).术中胆汁流量≥0.19 ml/min的BA患儿术后3个月退黄率显著高于术中胆汁流量<0.19 ml/min的BA患儿(P<0.05).BA组的胆汁磷脂、TBA及DBIL浓度均显著低于对照组(P<0.05);BA组的胆汁ALT浓度显著高于对照组(P<0.01).术后3个月黄疸消除者的胆汁AST及TC浓度均显著低于未消除者(P<0.05).结论 BA术中胆汁流量与预后有明显的关系,患儿术中胆汁流量越好,术后的预后越好,提示术中胆汁流量可以更早地预测患儿的远期效果.BA胆汁成分的变化说明BA患儿的肝功能较差,胆汁中磷脂、TBA和DBIL浓度较低可能是肝脏分泌功能较差的表现.胆汁中的AST和TC浓度与预后有关,胆汁AST和TC浓度较低的BA患儿术后预后较好,可能是由于肝功能较好和胆汁粘度较低利于引流所致.

Analysis of the bile flow in biliary atresia

Objective To assess the prognostic values of intraoperative bile flow and bile components in patients with biliary atresia. Methods The intrahepatic bile of 27 children with biliary atresia (BA) were collected intraoperatively. The bile collected from 17 children with choledochal cysts in surgery were studied as the control group. Bile flow was monitored in 7 cases. The concentrations of phospholipid, total protein (TP), bile acid (TBA), the total bilirubin (TBIL), direct bilirubin (DBIL),total cholesterol (TC), aspartate aminotransferase (AST), alanine aminotransferase ( ALT), γ- glutamine (GGT),alkaline phosphatase (ALP) in bile were measured. Patients with BA were followed for 1-6 months post-operatively. The information collected during the follow-up included the time when the jaundice disappeared,the blood biochemistry and onset of cholangitis. Results The bile flow of children with BA were significantly lower than that in the control group (P<0. 05). The bile flow of children with BA whose operative age > 60 days or preoperative blood ALT > 150 U/L were significantly lower than that in the control group (P<0. 05). The jaundice-relieving rate 2 months post-operatively in children with BA whose bile flow ≥0. 19 ml/min was significantly higher than that in patients whose bile flow <0. 19 ml/min (P<0. 05). The concentrations of phospholipid,TBA and DBIL in bile of children with BA were significantly lower than those in the control group (P<0. 05). The concentration of ALT in bile of patients with BA was significantly higher than that in the control group (P<0. 01 ). The concentrations of AST and TC in bile of children with BA whose jaundice have been relieved before the third month postoperatively were significantly lower than those in with persistent jaundice (P<0. 05). Conclusions The correlation between the intraoperative bile flow and the prognosis is significant in children with BA: the faster the bile flow, the better of prognosis. This suggested that the intraoperative bile flow can effectively predict the long-term prognosis of BA after Kasai operation. The change of bile components in bile of BA indicated that the hepatic function of BA is poor, the lower concentrations of phospholipid,TBA and DBIL in bile may be due to poor hepatic function. The correlations between the concentrations of AST and TC in bile and prognosis were significant:, the lower of the concentration of AST and TC, the better of prognosis.