先天性胆总管囊肿致肝脏病损的临床分析及转归

The Pathological Changes of Liver in Congenital Choledohal Cyst:Clincal Analysis and Prognosis

为了对儿童先天胆总管囊肿（ＣＢＤ）导致肝脏病损的有关临床因素及其转归进行分析， 对收治的３７例先天性胆总管囊肿患儿按肝脏病理改变的程度分成三组：肝硬变组１５例，肝硬变前期组２０例及正常肝细胞组２例。结果，肝硬变组年龄明显小于肝硬变前期组，前者平均年龄１７．３７个月，后者为７０．２５个月（Ｐ＜０．００１）。肝硬变组患儿均有持续性贡疽史，肝硬变前期组有持续性黄疸史的仅３例，肝硬变组囊肿直径平均值为７．８ｃｍ，肝硬变前期组囊肿直径平均值为４．７ｃｍ（Ｐ＜０．０５）。肝硬变组９例获术后长期随访，８例恢复满意。结论：①ＣＢＤ患儿出现症状越早，肝硬变机会越大。 ②胆道梗阻是ＣＢＤ导致肝脏病损的主要原因。 ③ＣＢＤＩ型患儿囊肿越大，对胆流动力学影响越大， 对肝脏的影响也越大。 ④对已出现严重肝硬变的ＣＢＤ患儿仍应持积极态度，胆道梗阻解除后肝硬变仍有逆转的可能。

According to the pathological changes of the liver , 37 children with congenital biliary dilatation (CBD) were divided into three groups namely : cirrhosis group ( 15 ) , precirrhosis group ( 20 ) and normal liver cells group ( 2 ) . The average age of the cirrhosis group was 1 7. 37 months and that in the precirrhosis 70. 25 months (P<0. 01) . All cases of the cirrhosis group and 3 of the precirrhosis group had persistant jaundice. The average diameter of the cyst was 7. 8 cm in cirrhosis group but 4. 7 cm in precirrhosis group. Eight of the 9 cases with cirrhosis were followed-up with normal liver function. Conclusions . ( 1 ) The earlier the symptoms . the worse the cirrhosis :(2) Obstruction of the bile ducts is the main cause of liver cirrhosis; (3) The larger the cyst , the worse the liver features and (4) Active treatment should be given ,for ,patients with severe cirrhosis . because it is still reversible.