摘要
胆道闭锁是一种胆管进行性纤维化和肝内外胆管闭塞的婴儿胆管炎性病变。如能在早期明确诊断并且施行手术（Kasai手术〈60 d）可显著改善患儿预后，否则预后多不良。因此，其最大的挑战是尽量在出生后早期进行该病的准确诊断。近年来在胆道闭锁诊断方面取得了一些进展，比如粪便色卡或新生儿中血清胆红素的筛查。在筛查异常或出现临床不适后，使用一系列理化设备进一步检查，其中超声是一项非侵入性、廉价、操作性强的首选检查手段，其他检查方法包括磁共振胰胆管造影、经内镜逆行胰胆管造影术、十二指肠插管和肠液检测、放射性核素肝胆动态显影等。术中胆道探查、造影仍然是胆道闭锁诊断的金标准。尽管近年来研究提出一些新的观点，但目前仍然缺乏一个能够在早期诊断该病的理想方法，因此，胆道闭锁的早期诊断依然依赖于多技术、多方法的组合。
Biliary atresia（BA）is an inflammatory cholangiopathy of infancy with progressive biliary proliferation resulting in fibrosis and obstruction of extrahepatic and intrahepatic bile ducts, which mostly occurs in neonatal period.It is widely believed that the early diagnosis and timely surgical intervention（Kasai procedure within 60 days postpartum） of biliary atresia can lead to better prognosis for BA otherwise the poor prognosis would be caused, therefore the biggest challenge is to make an accurate diagnosis at the early stage after birth.Recently some progresses have been achieved in the diagnosis of BA such as stool color card screening and serum bilirubin measurements.If the screen result is abnormal or manifestations appear, further physical and chemical examinations are required.Ultrasonography is considered as a non-invasive, cost-efficient, easy-operated primary method to diagnose or exclude BA.Other choices are magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, duodenal tube test and dynamic examination of duodenal fluid and radionuclide hepatobiliary scanning.Intra-operative cholangiogram and liver biopsy remain the gold standards for diagnosing biliary atresia.Although some biomarkers and examinations have been proved distinct and potential for diagnosis of biliary atresia, an individual and ideal method has not been acknowledged.To conclude, a well-coordinated multidisciplinary approach is required in the assessment of suspected cases of biliary atresia, multi-technique and method combination is the strategy and direction in early diagnosis of biliary atresia.
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2017年第23期1826-1828,共3页
Chinese Journal of Applied Clinical Pediatrics
关键词
胆道闭锁
早期诊断
进展
Biliary atresia
Early diagnosis
Progress
