McClement J W, Howard E R, Mowat A P
Br Med J (Clin Res Ed). 1985 Feb 2;290(6465):345-7. doi: 10.1136/bmj.290.6465.345.
A postal survey identified 114 infants with biliary atresia (roughly one in 21 000 live births). Biliary operations were performed on 107. Of the 105 infants who were followed up, 35 were free of jaundice at 10 months to 3 1/2 years. Good results occurred most often in those operated on by 12 weeks and were also related to the number of cases operated on in each centre. Only two of 18 infants treated in centres dealing with one case a year were free of jaundice compared with 11 of 38 at centres treating two to five cases a year and 22 of 49 in a centre treating more than five cases a year. Jaundice in an infant of more than 2 weeks associated with yellow urine or pale stools is never physiological and requires urgent investigation to identify causes for which effective treatment may be possible. Identification of suspected cases by 4 weeks of age and a greater concentration of investigative and surgical skills should improve the short term results of surgery and the long term prognosis of biliary atresia.
一项邮政调查确定了114例胆道闭锁患儿（约占21000例活产婴儿中的1/21000）。对其中107例患儿进行了胆道手术。在接受随访的105例患儿中，35例在10个月至3岁半时黄疸消退。手术效果良好的情况最常出现在12周前接受手术的患儿中，并且也与每个中心进行手术的病例数量有关。在每年处理1例病例的中心接受治疗的18例患儿中，只有2例黄疸消退；而在每年处理2至5例病例的中心，38例中有11例黄疸消退；在每年处理超过5例病例的中心，49例中有22例黄疸消退。2周龄以上婴儿出现黄疸并伴有尿黄或粪便颜色变浅，这绝非生理性黄疸，需要紧急检查以确定病因，因为针对这些病因可能有有效的治疗方法。在4周龄时识别疑似病例，并集中更多的检查和手术技能，有望改善手术的短期效果以及胆道闭锁的长期预后。
