Verma Ajay, Dhua Anjan Kumar, Kandasamy Devasenathipathy, Gupta Amit, Bhatnagar Veereshwar
Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India.
J Indian Assoc Pediatr Surg. 2024 Jan-Feb;29(1):23-27. doi: 10.4103/jiaps.jiaps_24_23. Epub 2024 Jan 12.
The aim is to study intrahepatic biliary architecture in patients following Kasai's portoenterostomy for extrahepatic biliary atresia using magnetic resonance cholangiopancreatography (MRCP).
It is a prospective observational study in a cohort of patients who have survived with a complete jaundice-free period for at least 1 year. MRCP was done to look for various intrahepatic architectural changes during their last visit. Findings were correlated with liver functions and growth and development.
Twenty-one patients were included in the study. The male-to-female sex ratio was 1.6:1, the median age at surgery was 75 days (18-140 days), and the median age at magnetic resonance imaging (MRI) was 4 years (18 months-18 years). More than 2 years of follow-up was in seven patients. Left lobe hypertrophy was observed in six patients, right lobe hypertrophy was in three patients, intrahepatic biliary tract dilatation was in five patients, and altered signal intensity between intrahepatic ducts was seen in five patients. In addition, hypointense foci in the spleen were seen in one patient. Twelve children had normal weight for their age, ten children had the normal height for their age, and gamma-glutamyl transferase was elevated in all children. Only four children had a history of fever and jaundice.
The patients who survive after successful surgical intervention have near-normal liver gross architecture as on MRI/MRCP. Occasional findings of dilatation and lobar atrophy/hypertrophy are possible, especially in those with a history of cholangitis. The survivors also have acceptable growth parameters and normal liver functions.
本研究旨在利用磁共振胰胆管造影（MRCP）对肝外胆管闭锁患者行肝门空肠吻合术后的肝内胆管结构进行研究。
这是一项前瞻性观察性研究，研究对象为黄疸完全消退至少1年的存活患者队列。在他们最后一次就诊时进行MRCP检查，以寻找各种肝内结构变化。研究结果与肝功能以及生长发育情况相关。
本研究共纳入21例患者。男女比例为1.6:1，手术时的中位年龄为75天（18 - 140天），磁共振成像（MRI）时的中位年龄为4岁（18个月 - 18岁）。7例患者随访时间超过2年。6例患者观察到左叶肥大，3例患者观察到右叶肥大，5例患者观察到肝内胆管扩张，5例患者观察到肝内胆管之间信号强度改变。此外，1例患者脾脏出现低信号灶。12名儿童年龄别体重正常，10名儿童年龄别身高正常，所有儿童的γ-谷氨酰转移酶均升高。只有4名儿童有发热和黄疸病史。
成功手术干预后存活的患者，其MRI/MRCP显示肝脏大体结构接近正常。偶尔可能出现扩张以及叶萎缩/肥大的表现，尤其是有胆管炎病史的患者。存活者的生长参数也在可接受范围内，肝功能正常。
