放射性核素胆系显像鉴别诊断先天性胆道闭锁和婴儿肝炎综合征

DIFFERENTIATION OF BILIARY ATRESTA AND NEONATAL HEPATITIS WITH RADIONUCLIDE HEPATOBILIARY SCINTIGRAPHY

２３例临床难以确诊的高胆红素血症婴儿用放射性核素胆系显像作鉴别诊断．患儿年龄１９天～６月，男１６例，女７例．血清胆红素７１．８２～５４５．４９μｍｏｌ／Ｌ．静脉注射放射性药物后，肠道显示放射性者诊断为婴儿肝炎．２４小时肠道未见放射性者，用苯巴比妥５ｍｇ·ｋｇ－１·ｄ－１诱导７～１０天后再次显像，２４小时内肠道仍无放射性者诊断为先天性胆道闭锁．本组病例中婴儿肝炎８例，其中２例经药物诱导确诊．先天性胆道闭锁１５例．病理、手术和临床证实显像结果．所有病例均无副反应．表明这是较为可靠、安全、简便、实用的鉴别诊断黄疸的方法．

Abstract Differentiation of infantile jaundice is a critical and difficult problem. This paper retrospectively evaluated the use of hepatobiliary scintigraphy in 23 consecutive infants with neonatal cholestasis. The direct serum bilirubin concentration was 71.82～ 545.49μmol / L. During the first study,only six of the 23 patients had gastrointestinal excretion of the tracer.In 17 patients without excretion, a second study was done after oral administration of phenobarbital 5mg·kg-1. d-1 for 7 to 10 days. The gastrointestinal excretion of radionuclide was shown in 2 of the 17 patients. Final diagnosis of this group was: 15 cases with biliary atresia and 8 neonatal hepatitis, including 2 cases whosegastrointeshnal excretion was noted on the second study.