Ohnuma N, Takahashi H, Tanabe M, Yoshida H, Iwai J
Department of Pediatric Surgery, Chiba University, School of Medicine, Japan.
Tohoku J Exp Med. 1997 Jan;181(1):67-74. doi: 10.1620/tjem.181.67.
We performed a total of 75 examinations with endoscopic retrograde chlangiopancreatography (ERCP) in 73 infants aged from 8 days to 300 days (mean 71 days) between 1977 and 1995. ERCP examination was performed with a prototype duodenoscope and was successful in 47 of 52 examinations in biliary atresia, 9 of 11 in neonatal hepatitis, all 4 in paucity of intra-hepatic bile duct, 4 of 5 in congenital biliary dilatation, 1 of 2 in duodenal stricture, and 1 case of in postoperative jaundice of hepatoblastoma. In 46 infants with biliary atresia, excluding one in whom the findings could not be evaluated due to poor x-ray image quality, we distinguished the following four patterns of ERCP findings: Pattern 1, only the pancreatic duct could be demonstrated and no bile duct was visualized (76%); Pattern 2, only a part of the distal common bile duct with the pancreatic duct was visualized (2%); Pattern 3, the entire length of the common bile duct with the pancreatic duct was visualized without the gallbladder and the common hepatic duct (4%); and Pattern 4, the common bile duct and the gallbladder with the pancreatic duct were visualized without the common hepatic duct (18%). In all of these 46 patients, laparotomy, an operative cholangiogram, and histological evaluation of the biliary duct were performed. In 9 neonates with neonatal hepatitis, the biliary tract was opacified and biliary atresia was excluded. Laparotomy was thus avoided in these neonates. There was no complication caused by either ERCP or by anesthesia.
1977年至1995年间，我们对73例年龄在8天至300天（平均71天）的婴儿进行了总共75次内镜逆行胰胆管造影（ERCP）检查。ERCP检查使用的是十二指肠镜原型，在52例胆道闭锁检查中有47例成功，11例新生儿肝炎中有9例成功，4例肝内胆管稀少全部成功，5例先天性胆管扩张中有4例成功，2例十二指肠狭窄中有1例成功，肝母细胞瘤术后黄疸1例成功。在46例胆道闭锁婴儿中，除1例因X线图像质量差无法评估结果外，我们将ERCP检查结果分为以下四种类型：1型，仅能显示胰管，未见到胆管（76%）；2型，仅能看到部分胆总管远端与胰管（2%）；3型，可见胆总管全程与胰管，但无胆囊和肝总管（4%）；4型，可见胆总管、胆囊与胰管，但无肝总管（18%）。对这46例患者均进行了剖腹手术、术中胆管造影及胆管组织学评估。9例新生儿肝炎患儿的胆道显影，排除了胆道闭锁。因此这些新生儿避免了剖腹手术。ERCP及麻醉均未引起并发症。
