腹腔镜辅助胆道造影在幼婴延迟性黄疸诊断中的价值

目的探讨腹腔镜辅助胆道造影在幼婴延迟性黄疸诊断中的价值。方法首先脐部置镜观察胆囊及肝脏情况,如果胆囊大小正常或基本正常,通过右肋缘下trocar孔拖出胆囊底部,部分患儿需游离胆囊系膜。切开胆囊,插管行胆道造影。如果胆囊呈纤维闭锁状态,不能拖出腹腔外,中转开腹。切开胆囊插管失败,放弃造影。结果12例患儿直接从拖出胆囊行胆道造影显示婴儿肝炎综合征或胆汁淤积8例;2例显示为胆管发育不良;2例为肝内胆管闭锁。5例从肝脏游离胆囊系膜后拖出造影,2例显示为胆管发育不良,3例提示胆道闭锁。其余21例患儿胆囊呈条索状,不同程度肝硬化,放弃胆道造影,诊断为胆道闭锁。所有胆道闭锁患儿均行Kasai手术。结论腹腔镜探查、胆道造影是诊断胆道闭锁、鉴别幼婴延迟性黄疸简便、准确、安全的方法,能够显示整个胆树的解剖结构,避免过大或不必要的创伤。

Value of Laparoscopie-assisted Cholangiography in the Diagnosis of Prolonged Jaundtce in Infants

Objective To evaluate the value of laparoscopic-assisted cholangiography in diagnosing prolonged jaundice in infants. Methods Through an umbilical troear, an laparoscope was placed into the abdominal cavity to detect the gallbladder and liver. After confirming that the cholecyst is normal, we pulled out the fundus of the gallbladder through the right subcostal trocar, and then inserted a catheter into the gallbladder for cholangiography. If the fundus could not be exteriorized because of gallbladder atresia, the patient would be converted to an open surgery. Results Cholangiography showed infant hepatitis syndrome or cholestasis in 8 cases, biliary hypoplasia in 2, and biliary atresia in 2. In 5 patients, the gallbladder was dissected from the liver bed before cholangiography, 2 of them had biliary hypoplasia and 3 showed biliary atresia. Cholangiography was given up in 21 children because of liver cirrhosis. These patients were diagnosed with biliary atresia and then were treated by Kasai portoenterostomy. Conclusions Laparoscopic-assisted eholangiography is a simple, accurate, and safe method in the diagnosis of prolonged jaundice in infants. By using the procedure, the whole biliary tree can be shown clearly without leading to serious injuries.