Early Laparoscopic Intervention In Infant Obstructive Jaundice

Background:As we know,the common cause of obstruction jaundice lies in three kinds of dieases,they are congenital biliary atresia,concentration bile suppository syndrome and congenital bile duct dysplasia,and they are often hard to identification in early time.so during the diagonosis process time made congenital biliary atresia patient lost operation opportunity.so early diagonosis the diease is still very important.The majority clinical manifestation of concentration bile suppository syndrome patience is the damage of liver function.serum indirect bilirubin and direct bilirubin are all increased,but indirect bilirubin increased higher than direct bilirubin,this kind of patience can increase liver damage during the operation.and it can aggravate the jaundice after operation and increase the treatment difficulty,so this kind of patience is unsuitable to operation.but there are still a lot of patients who has obstructional jaundice in clinical and the stool looks like pottery clay.and the sclera looks dark green.The serum indirect bilirubin and direct bilirubin are both increase,and the later is more higher than the former.The patiences are still in high bilirubin after long term of treatment.and they can not identificational from congenital biliary atresia or congenital bile duct dysplasia.If we can not get good efficacy after conservation treatment and we take a long time.It is easy to result to irreversibility liver cirrhosis.so it will effect the patiences survival quality.what's more it will endanger the patiences's life.So early diagnosis and early treatment is extremely important.But now days although there are mang methods to identification the obstruction jaundice,there still has not a specifically method.Objective:Through collect the infants with obstructive jaundice performed early laparoscopic intervention and cholangiography after two weeks of regular conservative treatments whom the bilirubin decrease unsignificantly in our department and to explore the value of early laparoscopic intervention in infant obstructive jaundiceData and methods:We retrospect the 56 obstructive jaundice patiences during January 2004 and December 2007,who were under laparoscopic operation Among them,24 were boys and 32 cases were girls,they aged from 33 days to 106 days,and the average age is 58 days.Assisted inspection:serum total bilirubin:115～279μmol /L,and direct bilirubin were dominated increased AST ALT andγ-GT AKP were increased different degree.Ultresound inspection:the liver had different degree enlargement.And 45 patients of the livewr feeled rigid,40 patients of the spleen had enlarged and 45 patients of gallbladder were little gallbladder.10 patients had MRCP inspection.But all the patients can not checkout if the bile duct in or out the liver were existed.All the cases were treated by enzyme inducer and cholagogic in our hospital for 2 weeks.because the bilirubin decreased singnificantly,so they were taken to surgical department and done the biliary exploration by laparoscopy.Results:All the cases were found that the liver was cholestasis under laparoscopy,and they were different degree nodule change.12 patients of the bile duct were vertificated well after angiography,and pathological inspection showed that the bile duct had different degree hyperplasia in portal tract area and bile embolism in the liver.They were diagonosed as cholestatic syndrome Postoperatively,10-20ml saline was infused into biliary duct through the irrigation tube every day at the first week.After the first week,irrigation adjusted to every 2 to 3 days according to bilirubin levels and liver function.the jaundice was decreased after the biliary washing and protecting liver and cholagogic treatment.4 cases were diagonosed as congenital bile duct dysplasia,and the jaundice was decreased after the biliary washing and protecting liver and cholagogic treatment.40 patients were diagonosed as biliary atresia because the dile duct was part development or can not find completely,they were done the kasai operation or give up operation depending on their parents requirement.Conclusion:Early laparoscopic intervention in infant obstructive jaundice can do early diognosis and early correct treatment after two weeks normal treatment.It has high clinical practical value.To the cholestatic syndrome and congenital bile duct dysplasia patients,we can bile cyst fistulization and biliary tract irrigation in order to reduce futher damage to the liver by cholestasis.To the biliary atresia patients,we can strive for early operation opportunity and improve operation efficacy.