Senyüz O F, Yeşildağ E, Emir H, Tekant G, Bozkurt P, Sarimurat N, Söylet Y
Department of Pediatric Surgery, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
J Pediatr Surg. 2001 Mar;36(3):463-5. doi: 10.1053/jpsu.2001.21621.
The early diagnosis of surgical jaundice in a neonate is an important step for the surgical success in extrahepatic biliary atresia. Diagnostic laparoscopy, as in many areas in surgery, is included in the conventional diagnostic methods of extrahepatic biliary atresia.
Since 1992, 24 infants with prolonged jaundice, in whom extrahepatic biliary atresia and neonatal hepatitis could not be differentiated with conventional diagnostic interventions, have been evaluated laparoscopically.
A coarse, irregular, greenish-brown liver with some degree of fine angiomatous development and an atretic gallbladder are the findings of laparoscopic evaluation in an infant with extrahepatic biliary atresia. However, in neonatal hepatitis, the liver is smooth, sharp-edged, and chocolate brown in color, and simultaneously performed cholangiography should show the passage of the contrast material both into the proximal biliary tracts and the intestinal system. In this series, 10 of 24 cases were proved to be neonatal hepatitis diagnosed by laparoscopy, so unnecessary laparotomy was avoided in 42% of the cases.
When the diagnostic laparoscopy, in which the liver and the gallbladder are directly visualized, is combined with the cholangiographic examination, the most accurate and earlier diagnosis in an infant with prolonged jaundice can be achieved, and the important period of time for the surgical success in extrahepatic biliary atresia will be minimally wasted.
新生儿外科性黄疸的早期诊断是肝外胆道闭锁手术成功的重要步骤。与许多外科领域一样，诊断性腹腔镜检查被纳入肝外胆道闭锁的传统诊断方法中。
自1992年以来，对24例黄疸持续时间较长、通过传统诊断干预无法区分肝外胆道闭锁和新生儿肝炎的婴儿进行了腹腔镜评估。
在患有肝外胆道闭锁的婴儿中，腹腔镜评估的结果是肝脏粗糙、不规则、呈绿褐色，有一定程度的细小血管瘤样改变，胆囊闭锁。然而，在新生儿肝炎中，肝脏光滑、边缘清晰、呈巧克力棕色，同时进行的胆管造影应显示造影剂进入近端胆道和肠道系统。在本系列中，24例中有10例经腹腔镜检查证实为新生儿肝炎，因此42%的病例避免了不必要的剖腹手术。
当直接观察肝脏和胆囊的诊断性腹腔镜检查与胆管造影检查相结合时，可以对黄疸持续时间较长的婴儿实现最准确、更早的诊断，并且将肝外胆道闭锁手术成功的重要时间段的浪费降至最低。
