Early Exclusive Diagnosis of Biliary Atresia among Infants with Cholestasis

B. Choe
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引用次数: 2

Abstract

The persistence of jaundice beyond the first 2 weeks of life require further investigation and this can be determined if the conjugated bilirubin levels are greater than 1.5 mg/dL or greater than 20% of the total bilirubin level. There is a diverse differential diagnosis for the cause of neonatal cholestasis due to hepatobiliary disease including biliary atresia, which eventually leads to liver cirrhosis if uncorrected before 60∼80 days of life. Long-established initial studies include abdominal ultrasonography, hepatobiliary scintigraphy and liver biopsy, but better diagnostic methods are needed. Promising new options are described including MRCP (magnetic resonance cholangiography), ERCP (endoscopic retrograde cholangiography), and PCC (percutaneous cholecysto-cholangiography). Though no single test can differentiate biliary atresia from other neonatal cholestasis with confidence, a combination of diagnostic methods is usually consistently beneficial. By excluding biliary atresia as early as possible, the risk of unnecessary explolaparotomy with intraoperative cholangiography is decreased. Further evaluation would be required for the diagnosis of neonatal cholestasis after excluding biliary atresia. (Korean J Pediatr Gastroenterol Nutr 2011; 14: 122∼129)
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胆汁淤积症患儿胆道闭锁的早期诊断
如果黄疸持续超过出生后2周,则需要进一步调查,如果结合胆红素水平大于1.5 mg/dL或大于总胆红素水平的20%,则可以确定。新生儿胆汁淤积症是由胆道闭锁等肝胆疾病引起的,如果在出生后60 ~ 80天前不加以纠正,最终会导致肝硬化。长期建立的初步研究包括腹部超声检查,肝胆造影和肝活检,但需要更好的诊断方法。有希望的新选择包括MRCP(磁共振胆管造影),ERCP(内镜逆行胆管造影)和PCC(经皮胆囊胆管造影)。虽然没有单一的测试可以准确地区分胆道闭锁和其他新生儿胆汁淤积症,但综合诊断方法通常是有益的。通过尽早排除胆道闭锁,可以降低术中胆道造影进行不必要的开腹探查的风险。排除胆道闭锁后,需要进一步评估新生儿胆汁淤积症的诊断。韩国儿科胃肠病学杂志2011;14: 122∼129)
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