摘要
目的 通过解剖胆道闭锁患者肝脏肝门组织，探讨Kasai术后肝门改变与肝内病理改变的差异，为改进Kasai手术提供理论依据。方法 收集Kasai术后因胆汁淤积性肝硬化而行肝移植的胆道闭锁患儿13例，将其中术后胆汁引流情况较差者作为引流不良组，切取肝门及肝内组织。收集3例Kasai术后因肝门部囊肿，反复发作胆管炎而行肝移植的胆道闭锁患儿，3例术后胆汁引流较好，为引流良好组，自吻合口开始，沿左右肝管分别间隔1cm连续取材。结果 引流不良组：肝内病理改变以纤维化加重、胆管增生及血管增生为主，增生胆管直径较小，肝门淤胆程度较肝内相对重。引流良好组：靠近肝门部位胆管增生较肝内轻，并以大胆管为主。肝左叶胆管直径较大（最大750μm），具有引流功能；肝右叶胆管增生明显，胆管直径较小（最大390μm）。结论 Kasai术后胆汁引流较好的病例均呈现左叶胆管直径较大，可能提示解剖肝门广度需要增加。
Objetive To explore the differences between the hepatic lilar change and the pathological changes of liver after Kasai portoenterstomy through the anatomy of hepatic hilar region with BA, and to provide theoretical basis for improving Kasai operation. Methods The patients were collected and grouped. The first group （the poor drainage group） includes those with poor biliary drainage among 13 cases with BA who received liver transplant surgery due to Cholestatic cirrhosis after Kasai portoenterstomy. Take biopsy from their porta hepatis and liver tissue. The second group （the good drainage group） includes 3 cases with BA who received liver transplant surgery due to recurring cholangitis caused by cyst in hepatic hilar region. Take biopsy from 1cm to hepatic duct in both sides. Results Poor drainage group： intrahepatic pathological changes were primarily found in liver fibrosis, bile duct proliferation, and vascular proliferation. The bile duct＇ s diameter is relatively small, and the hepatic cholestasis is more severe than the introhepatic one. Good drainage group： bile duct hyperplasia is mainly large ones and it＇ s more severe near the porta hepatis than in the liver. The bile duct in the left lobe of liver has big diameter （ maximum of 750 μm） and the function of drainage ; while those in the right lobe of liver has small diameter （maximum of 390 μm） , and the bile duct hyperplasia is obvious. Conclusion All the cases with better biliary drainage after kasai portoenterstomy were found bigger bile ducts in the left lobe of liver, which may indicate that dissection should be made to wider area in the hepatic hilar region.
出处
《临床小儿外科杂志》
CAS
2015年第1期20-24,共5页
Journal of Clinical Pediatric Surgery
基金
天津市卫生计生委攻关项目(项目号:14KG129)
关键词
胆道闭锁
病理状态
解剖学
Biliary Atresia
Pathological Conditions, Anatomical
