腹腔镜下胆道美蓝显色对婴幼儿梗阻性黄疸的诊断研究

Laparoscopic-assisted with methylene blue staining in biliary for the diagnosis of obstructive jaundice in infants

目的探讨腹腔镜下胆道美蓝显色在婴幼儿梗阻性黄疸诊断中的应用价值。方法梗阻性黄疸患者32例,男12例,女20例,年龄52～155 d,平均68d;术前行相关检查未能确定病因。在腹腔镜下行胆道美蓝显色、胆囊置管造影检查。结果32例患儿中10例因胆囊细小干瘪不能提出,造成胆囊穿刺困难,腹部开一小口完成胆囊穿刺,部分行置管照影,其它均在腹腔镜下完成操作,20例胆管、十二指肠美蓝未显色则诊断为先天性胆道闭锁,12例诊断为胆汁淤积症。胆道造影18例诊断为先天性胆道闭锁,其中9例开腹行肝门空肠吻合术(Kasai术),14例诊断为胆汁淤积症,前后两次诊断结果进行卡方检验,P值>0.05,结果无显著性差异。结论腹腔镜下胆道美蓝显色在梗阻性黄疸的诊断中具有操作简单、经济、安全、直观的优点,结合胆囊形态及穿刺结果,对于胆道闭锁与胆汁瘀积可以基本作出诊断,但相对胆道照影来仍有一定的局限性,对于没有床边X线机条件的基层医院,仍是诊断婴幼儿梗阻性黄疸的一种较好的方法。

Objective To explore the value of laparoscopic-assisted with methylene blue staining in biliary for the diagnosis of obstructive jaundice in infants.Methods 32 infants with obstructive jaundice,12 male and 20 female,which were day of 52～155（average 68d）,were checked by laparoscopic-assisted with methylene blue staining in biliary and then inserted a catheter into the gallbladder for cholangiography.Results 10 cases were failed in laparoscopy because of the little gallbladder,while methylene blue staining in biliary showed congenital biliary atresia in 20 cases,cholestasis in 12.Cholangiography showed congenital biliary atresia in 18 cases,cholestasis in 14 cases.There was no significant difference in the two groups by Chi Square Test.Conclusions Laparoscopic-assisted with methylene blue staining in biliary is a simple,economical,safe,obvious method in the diagnosis of obstructive jaundice in infants.By this method and combining the shape and puncturing of gallbladder,biliary atresia and cholestasis can be diagnosed.It is a good method of diagnosing obstructive jaundice in infants in the primary hospital.