论文部分内容阅读
目的 :探讨ECT对婴儿梗阻性黄疸诊断、及鉴别诊断的价值 ,对临床治疗方法进行评价。 方法 :应用ECT核素对 2 2例已诊断为梗阻性黄疸的患儿进行肝胆肠道动态显像检查 ,明确临床诊断 ,鉴别梗阻部位和性质。 结果 :8例胆道延时 ,核素显像为胆汁淤滞型阻塞型黄疸。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。 14例为先天性胆道闭锁 (肝外型 8例、肝内型 6例 ) ,有肝胆显像 ,但肠道不显像。其中 12例 (肝外型 8例、肝内型 4例 )行Kasai手术 ,术后均有胆汁排出 ,4例术后死亡 ,3例因胆瘘再次行肝门空肠吻合术均死亡 ,手术后存活 5例 (35 % )。另外 2例未及手术者死于肝衰竭。 结论 :ECT核素延迟显像可鉴别梗阻性黄疸的性质和部位。年龄小于 6 0d的胆汁淤滞性黄疸患儿先应以药物抗感染、保肝、中药、利胆素及地塞米松适量应用治疗 2周 ,如胆红素升高则手术治疗。先天性胆道闭锁患儿应在适当药物治疗尽早手术。
Objective: To investigate the diagnostic value of ECT in obstructive jaundice in infants and the value of differential diagnosis, and evaluate the clinical treatment. Methods: Twenty-two children diagnosed as obstructive jaundice with ECT nuclide were examined by dynamic imaging of liver, gallbladder and intestine to confirm the clinical diagnosis and identify the site and nature of the obstruction. Results: 8 cases of biliary delay, radionuclide imaging of cholestatic obstructive jaundice. Among them, 5 cases were cured by jaundice aggravating tube cannula pressure tube flushing and 3 cases were cured by jaundice. 14 cases of congenital biliary atresia (extrahepatic type in 8 cases, 6 cases of intrahepatic type), hepatobiliary imaging, but not the gut. Among them, 12 cases (8 cases of extrahepatic type and 4 cases of intrahepatic type) underwent Kasai operation. All patients had bile excretion after operation, 4 cases died after operation, 3 cases underwent reoperation of hepatic portal jejunum due to biliary fistula, Survival in 5 cases (35%). The other 2 patients died of liver failure without surgery. Conclusion: Delayed imaging of ECT nuclide can identify the nature and location of obstructive jaundice. Children younger than 60 days of cholestatic jaundice should be treated with anti-infective drugs, liver protection, traditional Chinese medicine, licorice and dexamethasone appropriate amount of treatment for 2 weeks, such as elevated bilirubin surgery. Children with congenital biliary atresia should be treated as soon as possible in the appropriate medical treatment.