手术结合激素治疗婴儿肝炎综合征持续性黄疸

Surgical Intervention Combined with Steroid Therapy on Persistent Jaundice in Infantile Hepatitis

目的探讨手术结合激素治疗婴儿肝炎综合征(INS)持续性黄疸的临床效果。方法对2007年1月-2008年12月收治的22例INS持续性黄疸患儿进行手术治疗(治疗组)。男19例,女3例;年龄2～6个月。证实为INS后,留置硅胶胆囊造瘘管,术中和术后每天用9g/L盐水、庆大霉素和地塞米松对患儿进行胆道冲洗14d,术后第3天开始予甲泼尼龙20、15、10、5mg,每剂量连续3d静脉滴注冲击后口服泼尼松4mg/(kg·d),2～3个月渐减量。取17例同期持续性黄疸INS患儿内科治疗进行对照(对照组)。随访并统计2组黄疸完全消退、生存例数和生存时间。结果2例手术探查发现为胆道闭锁,20例诊断为INS。治疗组黄疸消退率为90.0%,对照组为52.9%,治疗组黄疸消退率显著高于对照组(P<0.05)。治疗组2a生存率为89.7%,对照组为51.8%,2组比较有显著差异(P<0.05)。结论婴儿INS持续性黄疸的手术探查有助于排除胆道闭锁,从而避免误诊,胆道冲洗结合激素治疗可清除胆汁淤积,改善肝脏和胆管炎性反应,并增加胆汁流量,有利于清除黄疸,从而提高治疗效果。

Objective To investigate the effect of surgical intervention combined with steroid therapy on infantile hepatitis （INS） with persistent jaundice. Methods Twenty - two patients （ 19 males,3 females, aged 2 - 6 months） with persistent jaundice （ therapy group） were admitted into hospital in the period of Jan. 2007 - Dec. 2008. The patients were performed with surgical intervention after they were confirmed with diagnosis as INS, Then, sodium chloride, gentamicin and Dexamethasone were used to irrigate the biliary tract during and after the operation for 14 days. Three days after operation ,20 mg, 15 mg, 10 mg ,5 mg of methylprednisolone were administered intravenously to the patients every 3 days ,followed with 4 mg/（ kg.d） prednisone by oral for 2 - 3 months. The 17 cases of INS with persistent jaundice were treated with medicine as control（ control group）. By following - up ,the jaundice free and 2 years survival rate of 2 groups were compared by counting the cases of jaundice free and recording the survival time. Resets Two cases of 22 patients performed with surgical intervention were diagnosed as biliary atresia and others were INS,90.0% patients were free of jaundice in surgical intervention combined with steroid therapy group, which was higher than that in control group （ 52.9%, P 〈 0.05 ）. All cases with jaundice free could survive, and the rate of 2 - year survival in surgical intervention combined with steroid therapy group was 89.7%, while in control group it was 51.8% （ P 〈 0.05 ）. Conclusions Biliary atresia were found in the patients with INS with persistent jaundice by operation. So operation could decrease the rate of misdiagnosis. The biliary tract irrigation combined with steriod therapy could clean cholestasis, relieve the inflammation of hepar and bile duct and increase the bile flow,which could improve curative effects of INS.