Lampela Hanna, Pakarinen Mikko
HYKS, vatsaelinkirurgia.
Duodecim. 2013;129(14):1485-93.
Biliary atresia is a rare, neonatal, progressive cholestatic liver disease caused by fibroinflammatory obstruction of the biliary tree. Typical symptoms include prolonged neonatal jaundice, pale stools, and conjugated hyperbilirubinemia. Treatment starts with portoenterostomy, where fibrotic remnants of the extra hepatic bile ducts are replaced with small intestine. Best operative results are achieved among the youngest patients treated in specialized centres. Despite clearance of jaundice after a successful operation, fibrotic change of the liver continues in most. Liver transplantation serves as a salvage procedure if the portoenterostomy fails, or complications of liver cirrhosis develop after an initially successful portoenterostomy. In Finland, biliary atresia treatment was centralized in 2005. Of the patients treated thereafter, 90% are alive and over 80% with their native livers.
胆道闭锁是一种罕见的新生儿进行性胆汁淤积性肝病,由胆管树的纤维炎性梗阻引起。典型症状包括新生儿黄疸持续时间延长、粪便颜色变浅和结合胆红素血症。治疗始于肝门空肠吻合术,即将肝外胆管的纤维化残余部分用小肠替代。在专业中心接受治疗的最年幼患者中可取得最佳手术效果。尽管成功手术后黄疸消退,但大多数患者肝脏的纤维化改变仍会继续。如果肝门空肠吻合术失败,或在最初成功的肝门空肠吻合术后出现肝硬化并发症,肝移植可作为挽救性手术。在芬兰,2005年胆道闭锁治疗实现了集中化。此后接受治疗的患者中,90%存活,超过80%保留了自身肝脏。