怎样治疗胆道闭锁

如何治疗胆道闭锁配图，仅供参考

Surgical management of biliary atresia
Biliary atresia is uniformly fatal within one to two years if left untreated. Initial attempts at surgical management are undertaken in most cases. At laparotomy,the diagnosis of biliary atresia is confirmed by direct inspection of the extrahepatic biliary tree and intraoperative cholangiography. The fibrous remnant of the common bile duct is transected above the duodenal margin,and then the remnants of the common bile duct,cystic duct,gallbladder and common hepatic duct are dissected to identify their location anterior and superior to the bifurcation of the portal vein,where they enter a fibrous plate at the porta hepatis. This fibrous plate is dissected and transected at the level of the liver capsule,exposing a cut surface of hepatic parenchyma beneath. Rouxen-Y drainage is then fashioned using a limb of proximal jejunum anastamosed over the exposed hilar parenchyma. This operation has been known as the Kasai portoenterostomy since its original description by Kasai and Suzuki in 1957,and is reviewed in more detail elsewhere ). Interest in laparoscopic portoenterostomy has increased following early reports of improved visualization of the surgical field and successful outcomes ).
Most centres report successful re-establishment of bile flow and clearance of jaundice in 50% to 60% of infants who undergo the Kasai portoenterostomy. Large reported series ) from Europe and North America reveal medium-term survival without liver transplantation in 25% to 60% of patients after two to 10 years of follow-up examinations. A good patient outcome has been associated with early age (younger than 60 days) and the absence of cirrhosis at the time of Kasai portoenterostomy,fewer episodes of cholangitis following surgery and the long-term maintenance of good nutritional status ). Success may depend in part on the experience of the surgeon or centre ). Postoperative complications include recurrent cholangitis,which is most common in the early months after surgery,and manifestations of portal hypertension,including variceal hemorrhage.","department":"