临床小儿外科杂志2012，Vol.11Issue(4)：244-346,250,104.DOI:10.3969/j.issn.1671-6353.2012.04.002
Ⅲ型胆道闭锁不同亚型与预后关系的探讨
The relationship between the different types of extrahepatic biliary malformation and prognosis in Ⅲ type Biliary Atresia.
张金山 1李龙 1侯文英 1刘树立 1刁美 1明安晓 1刘垚 1王海滨1
作者信息
- 1. 首都儿科研究所外科,北京市,100020
- 折叠
摘要
Abstract
Objective To investigate the relationship between the different types of extrahepatic biliary malformation and prognosis in Ⅲ type Biliary Atresia (BA). Methods From June 2009 to October 2010, 64 patients (33 boys and 31 girls, age at operation: 31 ~ 131 days) with Ⅲ type Biliary Atresia underwent the Ka-sais procedure in our hospital. Before surgery, a cholangiography was performed in all of patients. The diagnosis of Ⅲ type Biliary Atresia was based on the cholangiography and the intraoperative findings. According to the state of gallbladder and extrahepatic bile duct showed by the cholangiogram, Ⅲ type Biliary Atresia was grouped into three subtypes: Ⅲa(the gallbladder without cavity and non-visualized gallbladder) , Ⅲb(the visualized gallbladder and common bile duct) and Ⅲc (the visualized gallbladder and non-visualized common bile duct). Postoperatively, all of patients were followed up. The contents included the biochemical indexes, cholangitis, jaundice clearance and survival during postoperative first year. Results The postoperative 3 month incidence of cholangitis: Ⅲa:67% (8/12) , Ⅲb: 45% (5/11), IHc:58% ( 11/19) . The postoperative 3 month rate of jaundice-clearance : Ⅲa:0(0/14) , Ⅲb: 12% (2/17) , LIc:21% (6/29) . The postoperative 6 month rate of jaundice-clearance: Ⅲa:21% (3/14) , Ⅲb:35% (6/17) , LIc:38% (11/29). The postoperative 1 year rate of death: LIa:60%(6/10) , Lib:50% (7/14) , LIc:48% (12/25) . The pre-and post-operative 1 month serum biochemical indexes, including ALT, AST, GGT, ALP, TBIL and DBIL, did not differ significantly between the subtypes (P >0. 05). The postoperative 2 month serum DBIL of the patients with Ⅲa type was higher than that of patients with Ⅲb type (69.3 ±28.2 vs 34.5 ±25. 5 ,P =0. 042). The postoperative 2 month serum DBIL of the patients with Ⅲa type was higher than that of patients with Ⅲc type (69. 3 ± 28.2 vs 34.2 ±26. 8,P =0. 021). The postoperative 3 month serum DBIL of the patients withⅢa type was higher than that of patients with He type (70. 8 ±8. 5 vs 30.4 ± 12. 8 ,P =0.004). The incidence of cirrhosis: IHa: 100% (12/12) , IHb:93. 8% (15/16) , IHc:96% (25/26). The ratio of less ductal proliferation to more ductal proliferation: Ⅲa: 1. 67(5/3) , Ⅲb: 1. 2(6/5) , Ⅲc: 0. 85(11/13). Conclusions Compared with Ⅲ b type and Ⅲ c type, Ⅲ a type had a bad prognosis, which suggested that the extra-hepatic biliary malformation is related with the prognosis of BA, but the pathogenesis is unclear.
关键词
胆道闭锁/外科学/胆道/畸形/预后Key words
Biliary Atresia/SU/ Biliary Tract/AB/ Prognosis引用本文复制引用
张金山,李龙,侯文英,刘树立,刁美,明安晓,刘垚,王海滨..Ⅲ型胆道闭锁不同亚型与预后关系的探讨[J].临床小儿外科杂志,2012,11(4):244-346,250,104.
