I型胆管闭锁的外科治疗

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第11卷期数: 2012年01期页码: 10-12 栏目: 论著出版日期: 2012-02-28

作者:: 詹江华管志伟罗喜荣包国强刘谊王栋; 天津市儿童医院普通外科

关键词:: ; 胆道闭锁/外科学; 胆汁淤积; 肝内; 治疗结果

文献标志码:: A

摘要:: 目的探讨I型胆管闭锁的外科治疗以及临床意义。方法2003~2011年，作者收治胆道闭锁患儿98例，其中伴有胆总管闭锁的I型胆管闭锁患儿5例，男3例，女2例，年龄62~127d。行胆囊—空肠吻合术2例，肝管—空肠吻合术3例。结果2例胆囊—空肠吻合术患儿退黄时间分别为术后10 d和术后17 d（退黄标准为总胆红素<20 μmol/L）；3例肝管—空肠吻合术患儿退黄时间分别为术后20 d、1个月和2个月（退黄标准同前）。术后随访时间1~5年；2例胆囊—空肠吻合术患儿术后未见黄疸反复。3例肝管—空肠胆道重建手术患儿中，1例术后未见黄疸反复，1例术后5个月出现黄疸，诊断为胆管炎，经抗炎治疗后好转；1例反复发作胆管炎最终选择肝移植。结论术中胆道造影是诊断胆道闭锁的金标准；如果术中造影证实为胆总管闭锁，且胆囊与左、右肝管通畅，主张采取胆囊—空肠吻合术。肝管—空肠吻合容易造成吻合口狭窄；过度解剖肝门对于术后恢复不利。

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