Purpose: Prednisolone is used routinely after portoenterostomy (PE) in patients with biliary atresia (BA).The authors reviewed their patients with BA post-PE to assess prednisolone protocols.Methods: Severity of fibro...Purpose: Prednisolone is used routinely after portoenterostomy (PE) in patients with biliary atresia (BA).The authors reviewed their patients with BA post-PE to assess prednisolone protocols.Methods: Severity of fibrosis at PE (moderate or severe), age at PE (30-70 days), size of bile ductules in the fibrotic biliary remnant at the porta hepatis (>100 μm), and type of BA (uncorrectable type) were used as criteria for selecting 63 subjects from our patients with BA post-PE.Subjects were divided into 5 groups according to prednisolone dosage: group 1, no prednisolone; groups 2 to 4, single courses of intravenous prednisolone commencing on day 7 post-PE administered in decreasing dose for 3 days each as follows: group 2, 6, 4, and 2 mg; group 3, 10, 5, and 2.5 mg; group 4, 20, 15, 10, 5, and 2.5 mg; group 5, same as group 4, but stool color was used to monitor bile excretion and a course was restarted from 20 mg whenever stools began to turn pale.If necessary, single courses were repeated until serum total bilirubin was less than 2.0 mg/dL.Protocol efficacy was assessed by comparing the number of patients who became jaundice free, the period taken to become jaundice free, and the incidence of side effects related to prednisolone.Results: The number of patients who became jaundice free in the no prednisolone group (group 1, 7/12 or 58.3%) was not significantly different from the number in the single-course groups (group 2, 8/12 or 66.6%; group 3, 10/13 or 76.9%; and group 4, 11/15 or 73.3%).The number in the stool-monitored group (group 5, 10/11 or 90.9%) was significantly greater (P <.05).The mean period taken to become jaundice free in group 1 (82.6 ±29.1 days) was not significantly different from the single-course groups (group 2, 74.5 ±29.3 days; group 3, 49.6 ±19.8 days; and group 4, 48.3 ±26.0 days).The mean period taken in the stool-monitored group (group 5, 33.3 ±6.4 days) was significantly shorter (P <.05).The number of subjects who developed cholangitis after becoming jaundice free was not significantly different (group 1, 2/7; group 2, 2/8; group 3, 2/10; group 4, 2/11; group 5, 2/10).There were no prednisolone-related complications identified in any subject.Conclusions: These results provide strong evidence that large-dose prednisolone therapy with stool color monitoring of bile flow has a positive impact on the time taken for patients with BA post-PE to become jaundice free and the number of patients who remain jaundice free.展开更多
Purpose The aim of this study was to describe a new technique for the surgical management of prenatally diagnosed small bowel atresia. Methods Under general a nesthesia, a 5-mm trocar was inserted using an open techni...Purpose The aim of this study was to describe a new technique for the surgical management of prenatally diagnosed small bowel atresia. Methods Under general a nesthesia, a 5-mm trocar was inserted using an open technique through an intrau mbilical incision. The proximal atretic bowel end was identified using laparosco py and mobilized toward the umbilicus using an additional 3-mm trocar inserted in the left lower quadrant. The umbilical trocar then was removed, and a ring re tractor was inserted into the trocar site and used to expand the wound to delive r both atretic bowel ends. The bowel was repaired and returned to the abdomen th rough the umbilical wound. The umbilical fascia and skin were closed conventiona lly. Results Three patients were reviewed. Two had minimal abdominal distension, and the atretic bowel ends could be identified easily; laparoscopy-assisted su rgery was successful. The third case had significant dilatation, and laparotomy was required. Postoperatively, there was minimal abdominal scarring, and the umb ilicus was normal in appearance. Conclusions Although this experience is limited to 3 patients, this technique is simple, safe, and virtually scar free and can be applied for the treatment of neonates with prenatally diagnosed small bowel a tresia, especially if there is minimal abdominal distension at birth.展开更多
文摘Purpose: Prednisolone is used routinely after portoenterostomy (PE) in patients with biliary atresia (BA).The authors reviewed their patients with BA post-PE to assess prednisolone protocols.Methods: Severity of fibrosis at PE (moderate or severe), age at PE (30-70 days), size of bile ductules in the fibrotic biliary remnant at the porta hepatis (>100 μm), and type of BA (uncorrectable type) were used as criteria for selecting 63 subjects from our patients with BA post-PE.Subjects were divided into 5 groups according to prednisolone dosage: group 1, no prednisolone; groups 2 to 4, single courses of intravenous prednisolone commencing on day 7 post-PE administered in decreasing dose for 3 days each as follows: group 2, 6, 4, and 2 mg; group 3, 10, 5, and 2.5 mg; group 4, 20, 15, 10, 5, and 2.5 mg; group 5, same as group 4, but stool color was used to monitor bile excretion and a course was restarted from 20 mg whenever stools began to turn pale.If necessary, single courses were repeated until serum total bilirubin was less than 2.0 mg/dL.Protocol efficacy was assessed by comparing the number of patients who became jaundice free, the period taken to become jaundice free, and the incidence of side effects related to prednisolone.Results: The number of patients who became jaundice free in the no prednisolone group (group 1, 7/12 or 58.3%) was not significantly different from the number in the single-course groups (group 2, 8/12 or 66.6%; group 3, 10/13 or 76.9%; and group 4, 11/15 or 73.3%).The number in the stool-monitored group (group 5, 10/11 or 90.9%) was significantly greater (P <.05).The mean period taken to become jaundice free in group 1 (82.6 ±29.1 days) was not significantly different from the single-course groups (group 2, 74.5 ±29.3 days; group 3, 49.6 ±19.8 days; and group 4, 48.3 ±26.0 days).The mean period taken in the stool-monitored group (group 5, 33.3 ±6.4 days) was significantly shorter (P <.05).The number of subjects who developed cholangitis after becoming jaundice free was not significantly different (group 1, 2/7; group 2, 2/8; group 3, 2/10; group 4, 2/11; group 5, 2/10).There were no prednisolone-related complications identified in any subject.Conclusions: These results provide strong evidence that large-dose prednisolone therapy with stool color monitoring of bile flow has a positive impact on the time taken for patients with BA post-PE to become jaundice free and the number of patients who remain jaundice free.
文摘Purpose The aim of this study was to describe a new technique for the surgical management of prenatally diagnosed small bowel atresia. Methods Under general a nesthesia, a 5-mm trocar was inserted using an open technique through an intrau mbilical incision. The proximal atretic bowel end was identified using laparosco py and mobilized toward the umbilicus using an additional 3-mm trocar inserted in the left lower quadrant. The umbilical trocar then was removed, and a ring re tractor was inserted into the trocar site and used to expand the wound to delive r both atretic bowel ends. The bowel was repaired and returned to the abdomen th rough the umbilical wound. The umbilical fascia and skin were closed conventiona lly. Results Three patients were reviewed. Two had minimal abdominal distension, and the atretic bowel ends could be identified easily; laparoscopy-assisted su rgery was successful. The third case had significant dilatation, and laparotomy was required. Postoperatively, there was minimal abdominal scarring, and the umb ilicus was normal in appearance. Conclusions Although this experience is limited to 3 patients, this technique is simple, safe, and virtually scar free and can be applied for the treatment of neonates with prenatally diagnosed small bowel a tresia, especially if there is minimal abdominal distension at birth.
