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目的了解新生儿肝外胆道囊性病变的不同类型及其临床特点,掌握其鉴别诊断的要点。方法分析9例新生儿肝外胆道囊性病变患儿的临床表现、肝功能、B超、CT、光镜、术中胆道造影的资料。结果本组胆道闭锁和新生儿胆总管囊肿女性多见,以梗阻性黄疸为主要表现,肝功能检查结果提示梗阻性黄疸。二者肝脏的组织学改变相似。但B超和CT检查发现,胆道闭锁组囊肿与胆囊大小均小于胆总管囊肿组。术中胆道造影显示,Ⅰ型胆道闭锁组肝内胆管变形、连续性中断;Ⅲ型胆道闭锁肝内胆管无法显示;胆总管囊肿组肝内胆管形态正常或略有被动扩张。结论多种胆道畸形都可以表现为新生儿肝外胆道囊肿,B超和术中胆道造影可以帮助鉴别这类疾病并且为治疗提供帮助。
Objective To understand the different types of neonatal cholangiocarcinoma and its clinical features, to master the main points of differential diagnosis. Methods The clinical data, liver function, B ultrasound, CT, light microscope and intraoperative cholangiography were analyzed in 9 neonates with extrahepatic cholangiocarcinoma. Results This group of biliary atresia and neonatal cholecyst cysts more common to obstructive jaundice as the main performance, liver function test results suggest obstructive jaundice. Histological changes in both liver are similar. However, B ultrasound and CT examination found that biliary atresia group cyst and gallbladder size were less than common bile duct cyst group. Intraoperative cholangiography showed that intrahepatic bile duct deformity and continuity were disrupted in type Ⅰ biliary atresia group; type Ⅲ biliary atresia could not be displayed in intrahepatic bile duct; intrahepatic bile duct shape in bile duct cyst group was normal or slightly passive distended. Conclusion A variety of biliary deformities can be manifested as neonatal extrahepatic cholangiocyst, B ultrasound and intraoperative cholangiography can help identify these diseases and to provide help for the treatment.