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小儿先天性胆管扩张症合并肝脏损害的临床及病理分析

Clinical and pathological analysis in children with congenital choledochal cyst combined with liver damage
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摘要 目的探讨小儿先天性胆管扩张症(congenital biliary dilatation,CBD)合并肝脏损害的病理基础及临床意义。方法 CBD患儿46例按年龄分为A、B两组,A组(1个月~3岁)24例,B组(4~16岁)22例。对两组临床特点、手术前后肝功能、术中情况及肝脏活组织病理检查等资料进行回顾性分析。结果 A组肝功能损害、碱性磷酸酶增高、胆红素增高及凝血功能异常较B组严重(P<0.05)。术中所见:囊肿远端明显狭窄闭锁29例(63.04%),A组24例,B组5例;远端有明显开口7例,均为B组;肝大、胆汁淤积明显10例,A组8例,B组2例;术中胆总管下端狭窄及梗阻A组较B组明显。肝脏活检结果:肝硬化改变10例,A组8例,B组2例,肝脏活检肝硬化改变A组发生率较B组高。结论不同年龄组CBD有各自的临床特点,年龄越小,囊肿越大,梗阻越重,肝脏损害越重,肝硬化改变机会越大;胆管梗阻胆汁淤积是肝脏损害的病理基础,早期诊断,早期手术治疗,胆管梗阻解除后肝脏损害可恢复。 Objective To explore the pathological basis and clinical characteristics of children with congenital biliary dilatation(CBD) combined with liver damage.Methods According to the age,46 patients with CBD were divided into 2 groups:Group A had 24 cases(ranged 1 month to 3 years old);group B had 22 cases(ranged 4 to 16 years old).A comparative analysis of them was conducted retrospectively in the clinical characteristics,hepatic pathological changes,perioperatively liver function and operation.Results Group A was obvious higher than group B in jaundice and white bole stool,but group B was more in stomachache.Group A was obvious higher than group B in liver function lesion,alkalin ephosphatase,bilirubin increase and blood coagulation disfunction(P0.05).Thirty-four cases had cysticbiliary dilatation.Twentyfour cases were in group A and 10 cases were in group B;12 cases had fusiform dilatation and were all in group B.Finding in operation,10 cases had calculus and albumen epistom in the cyst.Twenty-nine cases(63.04%) had obvious stenosis and a tresia in distal end.Twenty-four cases were in group A and 5 cases were in group B,7 cases had obvious debou chement in the distal end and were all in group B.Ten cases had obvious cholestasis,8 cases were in group A and 2 cases were in group B.The result of liver biopsy presented the followings:10 cases had liver cirrhosis,8 cases were in group A and 2 cases were in group B,and displayed that,the center of hepatic bile had generous cholestasis,cholochrome deposition and cell degeneration,the structure of normal hepatic bile was destroyed and apart of liver cells were atrophic.Group A was obvious higher than group B in stenosis and atresia in the distal end and liver cirrhosis rate.Conclusion CBD lead to the injury of liver function in different age group.They had the self characteristics in infants and children.The little the age,the larger the cyst,the worse the obstruction,the worse the liver cirrhosis.Obstruction of the bile ductsis was the main cause of liver in jury.It may recover after the biliary obstruction relieved by operation.
出处 《安徽医学》 2010年第8期882-886,共5页 Anhui Medical Journal
关键词 先天性胆管扩张症 病理学 肝功能检测 外科学 婴幼儿 Congenital biliary dilatation Pathology Liver function test Surgery Infant
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