Bile Decompression in Children with Histopathological Evidence of Pre-Existing Liver Cirrhosis
Bile Decompression in Children with Histopathological Evidence of Pre-Existing Liver Cirrhosis
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对已有肝硬化组织病理学证据的儿童进行胆汁减压
DOI：
10.1177/000313480206800917
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
Donald C. Liu
中科院分区：
文献类型：
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作者：
C. Jackson;Yeming Wu;Shi Chenren;S. Sømme;W. Chwals;Donald C. Liu
尽管大多数人都同意充分，及时的胆汁减压可以保留甚至改善现有的肝脏功能，许多辩论中心就已经存在的肝脏肝硬化是否也可以逆转，以帮助回答这一问题，我们分析了47个具有胆管囊肿儿童的数据。疾病（CD）在胆汁减压手术期间进行了简单的肝活检。时间段：1985年至1994年11月（A组）和1995年6月至1999年11月（B组）。在B组十个孩子（五个男孩和五个女孩一个月至7岁）中进行的CD。对于急性疾病后的急性目标，肝硬化程度是基于改良的世界卫生组织分类系统（0 – IV）。在所有情况下，肝脏功能改变的时间（III或IV）在随访中均具有正常的肝脏功能，在B组中丢失了6个（70％）。在第二次手术中，肝脏肝硬化较少，三个不变的肝脏（90％）仍然是正常的肝功能。正常的肝功能，甚至逆转严重的肝硬化。
Although it is agreed upon by most that adequate and timely bile decompression can preserve or even improve existing liver function much debate centers on whether pre-existing liver cirrhosis can also be reversed. To help answer this question we analyzed data on 47 children with choledochal cyst disease (CD) who underwent simultaneous liver biopsy during bile decompression surgery. We collected data on two groups of children with CD spanning two different time periods: January 1985 through November 1994 (Group A) and June 1995 through November 1999 (Group B). In Group A 37 children (16 boys and 21 girls ages 5 days to 10 years) underwent simultaneous liver biopsy during elective definitive surgery for CD. In Group B ten children (five boys and five girls age one month to 7 years) underwent liver biopsy twice: first during initial cyst decompression for acute obstruction and second during elective definitive surgery after resolution of acute disease. Degree of liver cirrhosis was based on a modified World Health Organization classification system (0–IV). In Group A 15/37 (40.5%) had significant liver cirrhosis at time of biopsy (III or IV) with altered liver function in all cases; eight of nine had normal liver function on follow-up, six were lost to follow-up. In Group B seven often (70%) had less liver cirrhosis on pathology at second operation with three unchanged; nine of ten (90%) regained normal liver function. We conclude that bile duct obstruction is the main cause of liver cirrhosis in children with CD. Adequate and timely bile decompression can restore normal liver function and even reverse severe cirrhosis.