Ecoffey C, Rothman E, Bernard O, Hadchouel M, Valayer J, Alagille D
Service d'Hépatologie Pédiatrique, Hôpital Bicêtre, France.
J Pediatr. 1987 Dec;111(6 Pt 1):824-9. doi: 10.1016/s0022-3476(87)80195-6.
We retrospectively studied the incidence of bacterial cholangitis in 129 infants operated on because of biliary atresia over 5 years. Forty-six of the 101 children who underwent hepatic portoenterostomy had a total of 105 episodes of cholangitis (range one to eight episodes per child). Most episodes occurred within 3 months of the operation. Factors associated with cholangitis included good or partial restoration of bile flow, abnormal intrahepatic bile ducts or cavities at the porta hepatis, and routine postoperative use of antibiotics. External jejunostomy was not effective in preventing cholangitis. In addition to fever and decreased bile flow, increased erythrocyte sedimentation rate and signs of shock were frequently observed. The responsible organisms, most often gram-negative bacteria, were identified in 79 (75%) episodes by blood or liver cultures. Most were susceptible to trimethoprim-sulfamethoxazole and third-generation cephalosporins during the first episode, but only to cephalosporins during later episodes. The incidence of signs of portal hypertension in children with normal serum bilirubin values at age 5 years was not higher in those who had previously experienced one or more episodes of cholangitis.
我们回顾性研究了5年间129例因胆道闭锁接受手术的婴儿发生细菌性胆管炎的发生率。101例行肝门肠吻合术的儿童中，46例共发生105次胆管炎发作（每名儿童发作1至8次）。大多数发作发生在术后3个月内。与胆管炎相关的因素包括胆汁流良好或部分恢复、肝内胆管异常或肝门处有空腔以及术后常规使用抗生素。外置空肠造口术对预防胆管炎无效。除发热和胆汁流减少外，还经常观察到红细胞沉降率升高和休克体征。通过血培养或肝培养在79次（75%）发作中鉴定出了病原菌，大多数为革兰氏阴性菌。在首次发作时，大多数病原菌对甲氧苄啶-磺胺甲恶唑和第三代头孢菌素敏感，但在随后的发作中仅对头孢菌素敏感。5岁时血清胆红素值正常的儿童中，既往有过一次或多次胆管炎发作的儿童门静脉高压体征的发生率并不更高。
