ABSTRACT
Objective To summarize the etiology and surgical treatment of obstructive infantile cholestasis.Methods Clinical data of 108 cases of obstructive infantile cholestasis was studied retrospectively from April 2009 to April 2014.Results Correct diagnosis was established in all 108 patients by laparoscopic biliary tract exploration and cholangiography.Among those,there were noncorrectable biliary atresia in 81 cases (75.0％),correctable biliary atresia in 5 cases (4.6％),inspissated bile syndrome in 8 cases (7.4％),infantile hepatitis syndrome in 6 cases (5.6％),choledochal cyst in 4 cases (3.7％),biliary hypoplasia in 2 cases (1.9％),1 case (0.9％) suffered from spontaneous bile duct perforation,1 case (0.9％) suffered from oppression of lymph nodes in hepatic portal.Patients of nocorrectable biliary atresia were treated with open Kasai portoenterostomy or laparoscopic Kasai portoenterostomy,correctable biliary atresia and choledochal cyst underwent laparoscopic cyst excision and Roux-Y hepaticojejunostomy,inspissated bile syndrome,infantile hepatitis syndrome and biliary hypoplasia were treated by laparoscopic cholecystostomy and biliary tract irrigation.The patient of spontaneous bile duct perforation was treated with laparoscopic common bile duct exploration and T-tube drainage,the lymph node was excised in patient with oppression of lymph nodes in hepatic portal.All infants were followed-up for 3 months to 48 months,the clearance of jaundice rate varied in patients with Kasai portoenterostomy,patients with non-Kasai portoenterostomy were all in good condition and there were no symptom recurrence.Conclusion Biliary atresia,inspissated bile syndrome,infantile hepatitis syndrome,choledochal cyst and biliary hypoplasia are the most common cause of surgery-related infantile cholestasis.Kasai portoenterostomy,hepaticojejunostomy and cholecystostomy and biliary tract irrigation are the main surgical method for surgery-related infantile cholestasis.
ABSTRACT
Objective To investigate the clinical features of pedistric Littre hernia.Methods Clinical data of 11 cases of Littre hermia admitted from January 2002 to December 2010 was studied retrospectively.Results The diagnosis of Littre hernia was all established by laparotomy.All of the 11 cases were boys,the median age was 1.2 years (22 days to 3 years and 7 months).The main clinical features were:painful,irregular and nonresetable mass in the groin area (11/11),vomiting in 6 cases (6/11 ),fever (＞38.5 ℃ ) in 4 cases (4/11 );X-ray showed intestinal obstruction in 9 cases (9/11 ),Ultrasound found mixed mass in the groin area in 11 cases ( 11/11 ),pouch-like structure were found in 6 cases (6/11).Eight cases (8/11) presented with elevated WBC ( ＞ 10000).Palpable lobulated structure were fell in 5 cases (5/11).All cases of Littre hernia were successfully operated on,Meckel diverticulum perforation was found in 2 cases ( 2/11 ),Meckel diverticulum adhered to the hernia sac in 8 eases (8/11).All patients were cured by surgery,and postoperative follow-up (10ms-8y) found no recurrence.Conclusions Pediatric Littre hernia is rare,preoperative diagnosis is difficult.Avoiding preoperative violent reduction and intraoperative injuring Meekel's diverticulum or the small bowel helps improve the cure rate of Littre hernia in children.