ABSTRACT
Objective To study the use of laparoscopy in the diagnosis and treatment of obstructive infantile cholestasis.Methods The clinical data of 106 patients with obstructive infantile cholestasis from January 2012 to June 2017 were studied retrospectively.After two weeks of conservative treatments which failed to decrease the bilirubin levels significantly,these patients were subjected to laparoscopic diagnosis and treatment.Results A correct diagnosis was established in all these 106 patients by laparoscopic biliary tract exploration and cholangiography.Eighty-eight patients were diagnosed to have biliary atresia (83.0％),16 patients inspissated bile syndrome (15.1％) and 2 patients biliary hypoplasia (1.9％).Thirty-eight of the 88 biliary atresia patients gave up operative treatment after laparoscopic biliary tract exploration and cholangiography.The remaining 50 biliary atresia patients were treated with open Kasai portoenterostomy.The prognosis of the biliary atresia patients were different from the non-biliary atresia patients.On follow-up for 4 months to 5 years,all the 18 non-biliary atresia patients were in good condition and there was no recurrence of jaundice after laparoscopic cholecystostomy and biliary tract irrigation.Conclusions The laparoscopic minimally invasive technique helped to establish diagnosis and treatment in patients with obstructive infantile cholestasis.For patients with biliary atresia,this procedure gave a definitive diagnosis and offered an opportunity for surgery.For patients with inspissated bile syndrome and biliary hypoplasia patients,laparoscopic cholecystostomy and biliary tract irrigation established the correct diagnosis and reduced liver damage resulted by cholestasis.
ABSTRACT
Objective To analyze the characteristics of external hydrocephalus in infancy with MR imaging,and to explore the cause of accumulation of extracerebral fluid and the relation with brain development.Methods Conventional magnetic resonance T_1 weighted imaging(T_1WI) and T_2 weighted imaging(T_2WI) were performed in 46 infants aged 2 years or younger with external hydrocephalus(EH),and the results were analyzed.They were divided into 7 age groups.The width of extracerabral space was measured on T_2WI and compared with normal standard.Results EH mainly resulted from infection,subdural hematoma or subarachnoid hemorrhage,HIE,which were 67.4%(31/46 cases) of the cases;EH with unknown cause were 26.1%(12/46 cases).EH was mainly located at the foreside of cerebral convexity,of which 80.4%(37/46 cases)was predominantly in the subarachnoid space,8.7%(4/46 cases) in subdural space,10.9% was subdural coexisted with subarachnoid collection.Duramater and piamater were high signal on T_1WI or T_2WI in purulent meningitis,and subdural or coexisted with subarachnoid collection often occurred.In subdural and(or) subarachnoid hematoma,subdural collection commonly coexisted with subarachnoid collection,and the cerebral cortical veins were often seen thickened diameter,stasis and hemorrhage with high signals on T_1WI.HIE caused subarachnoid collection,63.6%(7/11 cases) of which were concurred with delayed myelination.EH with unknown cause often appeared bilateral symmetrical subarachnoid collection.Enlargement of ventricular size were predominantly seen in HIE,subdural hematoma or subarachnoid hemorrhage.Conclusion EH often had definite etiological factor,which were mainly hemorrhage,infection and HIE.The location was associated with brain development.MR imaging was useful for judging reason and ascertaining character of EH.