胆道闭锁Kasai术后胆管炎的病因及诊治进展

Progress in the etiology,diagnosis and treatment of cholangitis after biliary atresia Kasai surgery

胆道闭锁是威胁新生儿生命的严重先天性肝内、外胆管畸形,目前针对该疾病的治疗主要依靠Kasai手术,即肝门-空肠吻合术纠正发育不良的胆道系统,胆管炎是胆道闭锁Kasai术后最常见且较难处理的并发症,发病机制尚未完全清楚,多种因素如肠道细菌的上行感染、肝内胆管发育异常及手术损伤、肠道内容物反流等都可影响疾病的发生发展。而胆管炎的首发时间、发生次数可影响术后原生肝脏功能,对其进行及时诊治尤为重要。Kasai术后胆管炎的诊断缺乏特异性,主要依据临床表现、生化异常以及手术史,对于难治性胆管炎应考虑完善放射性同位素肝胆成像、经皮胆道造影和小肠镜检查。其防治重点在于围术期的术前护理、术式改进和术后护理以及疾病随访过程中的药物防治等。

Biliary atresia is a serious congenital malformation that threatens the life of newborns.At present,the treatment of biliary atresia mainly relies on Kasai portoenterostomy which is also named hepatoportoenterostomy to correct the dysplastic biliary system.Cholangitis is the most common and intractable complication after Kasai portoenterostomy.The pathogenesis is still unidentified.Many factors including ascending infection of intestinal bacteria,abnormal development of intrahepatic bile duct,surgical injury,reflux of intestinal contentscan and so on can affect the occurrence and development of the disease.The initial time and frequency of cholangitis can affect the postoperative primary liver function,so it is especially important to diagnose and treat it timely.The diagnosis of post-Kasai cholangitis is lack of specificity,mainly based on clinical manifestations,biochemical abnormalities and surgical history.For intractable cholangitis should consider completing radioisotope hepatobiliary imaging,percutaneous cholangiography and single or double-balloon enteroscopy.The main focus of prevention and treatment lies in preoperative care,surgical improvement and postoperative care,as well as drug prevention during disease follow-up.