Millar A J, Davies M R, Rode H, Brown R A, Cywes S
S Afr Med J. 1986 Mar 1;69(5):288-93.
The surgical results in 39 children operated on for biliary atresia at Red Cross War Memorial Children's Hospital between January 1975 and January 1985 are reported. The mean age at operation was 12.8 weeks (range 6 weeks-6 months). In the first 4 years no patient had sustained bile drainage after operation. Since 1979 16 of 32 patients (50%) have had significant bile drainage. Of these, 8 are alive and have been followed up from 6 months to 6 years after operation. Five are jaundice-free and well. The other 3 are mildly jaundiced, have evidence of ongoing liver damage, and have a poor prognosis. The deaths were due to progressive liver damage with liver failure, portal hypertension, and intercurrent infection. Cholangitis after 'successful' porto-enterostomy was the main cause of poor prognosis and can be related to the age at referral and the presence of cirrhosis of the liver at the time of surgery; thus bile drainage does not necessarily equate with cure. Early referral of infants with conjugated hyperbilirubinaemia to a major centre is of paramount importance if we are to improve the prognosis.
本文报告了1975年1月至1985年1月期间在红十字战争纪念儿童医院接受胆管闭锁手术的39名儿童的手术结果。手术时的平均年龄为12.8周（范围6周 - 6个月）。在最初4年，术后无患者获得持续性胆汁引流。自1979年以来，32例患者中有16例（50%）获得了显著的胆汁引流。其中8例存活，术后随访6个月至6年。5例无黄疸且情况良好。另外3例有轻度黄疸，有持续肝损伤的证据，预后较差。死亡原因是进行性肝损伤伴肝功能衰竭、门静脉高压和并发感染。“成功”的门-肠吻合术后胆管炎是预后不良的主要原因，可能与转诊时的年龄以及手术时肝脏硬化的存在有关；因此，胆汁引流不一定等同于治愈。如果我们要改善预后，尽早将患有结合胆红素血症的婴儿转诊至主要中心至关重要。
