大便比色卡联合腹腔镜胆管造影对婴儿延迟性黄疸的诊断评估

The evaluation of infant stool color card combined with laparoscopy-assisted cholangiography in diagnosis of prolonged jaundice in infants

目的探讨大便比色卡联合腹腔镜胆管造影在婴儿延迟性黄疸诊断中的价值。方法72例延迟性黄疸患儿（男34例，女38例，平均日龄64d），由父母连续7d以上进行大便颜色观察并与比色卡对照：大便颜色持续异常者，以及大便颜色波动在正常与异常之间经内科治疗无效的患儿直接行腹腔镜探查和胆管造影、肝脏组织病理检查；大便颜色持续正常者，以及大便颜色波动在正常与异常之间经内科治疗转为正常的患儿则行内科治疗。所有患儿均行B超、MRCP、ECT检查并随访6～12个月。结果48例患儿大便颜色连续7d以上为异常，腹腔镜探查及胆管造影结果示：43例为胆道闭锁（BA），5例为非BA。14例患儿大便颜色持续至少7d正常，诊断为婴肝综合征（IHS），内科治疗并随访6～12个月全部治愈。10例患儿大便颜色波动在正常和异常之间，4例经内科治疗后大便颜色转为正常，排除BA行内科治疗，随访3例治愈，1例为漏诊BA；6例内科治疗后无变化，腹腔镜检查诊断1例为IHS，3例为BA，2例为胆道发育不良（CBDH）。72例患儿中8例（11．1％）非BA接受了腹腔镜胆管造影，大便比色卡诊断BA的灵敏度、特异度和准确率分别为97．9％、73．9％和90．0％。结论大便比色卡筛查延迟性黄疸患儿，有选择地行腹腔镜检查，显著降低了IHS患儿行腹腔镜检查比率，提高了BA的早期诊断准确性。

Objective To evaluate the accuracy of using infant stool color card combined with laparoscopy-assisted cholangiography in diagnosis of prolonged jaundice in infants. Methods Seventy- two infants were admitted for prolonged jaundice. The patients included 38 males and 34 females with an average age of 64 days old. The color of patients＇ stool was checked using infant stool color card by their parents for at least 7 days. The patients with persistent abnormal stool color or sharply fluctuated stool color were performed laparoscopy-assisted cholangiography and liver histopathological examination. The other infants, whose stool color was normal for more than 7 consecutive days or became normal after medical treatment, received conservative treatments. All children were followed up for 6 to 12 months. The ultrasonography, MRCP and ECT of the 72 infants were studied during follow-up. Results Among the 72 patients, 48 with abnormal stool color underwent laparoscopy-assisted cholangiography and liver histopathological examination. Biliary atresia （BA） was diagnosed in 43 patients. The 14 infants with normal stool color were diagnosed with infant hepatitis syndrome （IHS）, underwent medical treatment and all were cured. Among the 10 infants whose stool color sharply fluctuated, 4 infants＇ stool color turned to normal after medical treatment and were diagnosed with IHS （3 with IHS, the other 1 was finally diagnosed with BA after 6-12 months＇follow-up）. The other 6 infants underwent laparoscopic exploration and laparoscopic cholecystocholangiography. IHS was diagnosed in 1 case. BA was diagnosed in 3 cases and congenitalbile duct hypoplasia （CBDH） in 2. Only 8 patients （11.1 %）, who were finally diagnosed with IHS, was initially diagnosed with BA and underwent unnecessary laparoscopic exploration and laparoscopic cholecystocholangiography. The sensitivity, specificty and accuracy of using infant stool color card to diagnose BA was 97. 9%, 73. 9% and 90. 0% respectively. Conclusions Infant stool color card is accurate to screen BA in infants with prolonged jaundice. It can decrease unnecessary laparoscopic exploration and laparoscopic cholecystocholangiography.