Before 1950s, biliary atresia was almost impossible to cure. This disease was first reported in China 18 13. In 189 1, Tompson systematically analyzed and reported 49 cases of biliary atresia, including himself and those previously reported. Later, with the extensive and in-depth study of the etiology, pathology and hilar anatomy of biliary atresia, the surgical treatment of biliary atresia made epoch-making progress in the 1950s.
1957, Kasai performed the world's first hilar jejunostomy on a child with biliary atresia, which made the so-called "incurable" child with biliary atresia regain hope of survival. This operation was gradually accepted as the standard treatment for biliary atresia, and was named Kasai operation. Despite the continuous improvement of Kasai's surgical methods and curative effect, it still failed to satisfactorily solve various problems in the long-term survival of children with biliary atresia. After Gexi operation, due to various reasons, some children will have postoperative cholangitis, cystic dilatation of intrahepatic bile duct, portal hypertension, liver failure and other complications. Finally, about 2/3 children with biliary atresia need liver transplantation before adulthood.
Although gratifying achievements have been made in liver transplantation at present, it is reported that the annual survival rate of liver transplantation/kloc-0 in patients with biliary atresia is 98%, and the 5-year survival rate is over 95%. However, due to the serious shortage of liver sources in China, the heavy economic burden of patients and the lack of understanding of liver transplantation in China, liver transplantation for children with biliary atresia has not been carried out in time and effectively. Therefore, Kasai operation is still dominant in the treatment of biliary atresia.
At present, the common classification of biliary atresia is:
Type ⅰ: common bile duct atresia (10% of the total);
Type ⅱ: atresia of common hepatic duct (2% of the total);
Type ⅲ: hilar atresia (88%);
The first two types are considered correctable (anastomotic type) and the third type is considered uncorrectable (non-anastomotic type).
Some scholars call neonatal hepatitis syndrome and biliary atresia as infantile obstructive biliary diseases. According to the location of the lesion, it can be divided into four types:
(1) When the lesion only involves the liver, it is neonatal hepatitis;
(2) If the inflammation involves the extrahepatic biliary tract, which narrows but is not completely blocked, it is called biliary dysplasia. Sometimes this disease can be gradually improved, the lumen is enlarged and the biliary tract is unobstructed. Sometimes inflammation continues to develop, leading to complete biliary obstruction and biliary atresia;
③ If the obstruction is at the distal end of hepatic duct or gallbladder and common bile duct, it is "treatable" biliary atresia;
④ If the extrahepatic bile duct is seriously involved, the epithelium is completely destroyed, and all the bile ducts with structural fibrosis completely disappear, only those scattered in the residual mucosa are "incurable" biliary atresia. It is considered that biliary atresia caused by this reason accounts for 80% of the cases, while biliary atresia caused by congenital biliary dysplasia only accounts for 10%. Congenital causes are often accompanied by other congenital malformations. Biliary atresia is generally divided into intrahepatic and extrahepatic. Intrahepatic type shows irregular arrangement, stenosis or atresia of small hepatic ducts. Extrahepatic cases are stenosis, atresia or complete absence of any part of hepatic duct or common bile duct. Gallbladder fibrosis is shriveled and peanut-shaped, with a little colorless or white mucus inside. The gallbladder may not exist, and occasionally a normal gallbladder exists.
A baby with biliary atresia
The etiology of biliary atresia has not been clearly concluded. It was considered that the disease was congenital bile duct dysplasia in the early stage, which was related to the stagnation or disorder of bile duct system development in the 4 th ~10 week of embryo. However, biliary atresia was not found in the anatomy of biliary system of a large number of miscarriages or premature infants. On the contrary, there is more evidence in recent years to support that this disease is acquired. Some sick children have normal yellow feces at birth, and gray feces and jaundice appear a few weeks later, which also indicates that biliary obstruction in these children occurs after birth.
In addition, pathological examination showed inflammatory changes in liver tissue, inflammatory cell infiltration around hilum and bile duct, tiny pus focus or localized necrosis in hepatic lobule, and granulation tissue formation in bile duct occlusion. Through the comparative pathological study of extrahepatic biliary atresia and neonatal hepatitis, it is found that the liver tissue lesions of the two are similar, but the degree is different. Extrahepatic biliary atresia is mainly manifested as bile duct embolus and inflammatory lesions, especially infant hepatitis with hepatocyte necrosis. Therefore, it is now considered that biliary atresia may be an acquired disease similar to the pathological process of infant hepatitis. Biliary atresia after birth is the final stage and result of inflammatory process, which leads to scar and occlusion of bile duct fibers. The main cause of inflammation is viral infection, such as hepatitis B virus and cytomegalovirus, and may also be rubella virus, hepatitis A virus or herpes virus. Some scholars have suggested that abnormal pancreaticobiliary confluence may also be a congenital factor of biliary atresia.
Although there are many reasons for this disease, the final result is obstruction of bile excretion pathway and obstructive jaundice. Recent studies show that the development of intrahepatic and extrahepatic bile ducts are two sources, which can explain the situation that the lumen below the gallbladder can be unobstructed, while the lumen above the hepatobiliary duct is fibrotic and leads to atresia.
1, virus infection theory:
The research focus of this pathogen is mainly on cytomegalovirus (CMV), rotavirus (RRV), reovirus III and human papillomavirus (HPV).
2, immune damage theory:
Schreiber put forward the hypothesis of "multiple attacks" in 1993, which holds that a virus or toxin invades the bile duct epithelium, causing the bile duct epithelium to express a new antigen, which is recognized by T cells, triggering an autoimmune reaction, and eventually leading to bile duct epithelial damage and extrahepatic bile duct fibrosis. Zhuang et al. believe that innate immunity also plays an important role in the occurrence of ba. There may be some genetic defects in children with BA, which leads to the increased susceptibility of the body to unknown pathogens. * * * The pattern recognition receptor (PRR) of immune cells activates the innate immune system, which together with the acquired immune system leads to the occurrence and progress of BA.
3. The theory of graft versus host injury:
Microchimera-induced graft-versus-host injury in the mother may be involved in the occurrence of BA. BA and GVHD have many similarities:
A Cooper's cells, CD8+ and CD4+ lymphocytes were found around the damaged bile duct cells in the liver of children with BA, and their numbers and volumes increased, and their histological characteristics were similar to those of GVHD.
The inflammatory reaction between them is also related to the increased expression of adhesion molecules, HLA-ⅰ and HLA-ⅱ molecules in hepatocytes and bile duct epithelial cells.
It is found that maternal microchimerism may participate in the occurrence of some autoimmune diseases by initiating GVHD-like reaction, and maternal microchimerism may also participate in the occurrence of BA in the same way. There are maternal microchimerism in the liver of BA patients, which is related to the immune damage of BA, but a lot of research is needed to confirm that BA is a GVHD-like autoimmune disease induced by maternal microchimerism.
4, genetic etiology theory:
It is generally believed that Pakistan is not a genetic disease. However, Smith et al. reported cases of familial aggregation of BA in a pair of identical twin sisters and one of their siblings, and 29 cases of familial BA they recorded in the past supported the hypothesis that BA was caused by genetic and acquired factors. It is generally believed that there may be some susceptibility genes in BA patients, including DLK 1, CTGF, ICAM- 1, INV, CFC 1, jagged 1, MIF and so on.
5. Developmental abnormality theory:
Embryo BA can find the abnormal changes of biliary system before birth. Hinds et al. conducted a prenatal ultrasound study on 194 children with BA, among which 9 cases were diagnosed as biliary cystic malformation (4.6% of the total). The study of digestive enzymes in fetal period showed that bile obstruction caused by BA occurred in embryonic period, which provided evidence for the occurrence of BA in embryonic period. In addition to prenatal diagnosis, embryology also provides strong evidence for Ba's theory of dysplasia.
The failure of bile duct plate reconstruction is an important theoretical basis of BA dysplasia theory. According to the research, the abnormal bile duct in the hilar area of BA is very similar to the fetal bile duct plate. How is the bile duct plate remodeled? It was found that the mechanism of apoptosis was accompanied by the whole process of intrahepatic bile duct development. The activities of apoptosis and proliferation were higher in the unfinished bile duct plate, but lower in the completed bile duct plate, indicating that the remodeling of bile duct plate was influenced by the dual factors of regulating epithelial proliferation and apoptosis. Petersen et al reported the role of periportal interstitium in embryonic development: periportal interstitium can invade the liver fragments in contact with it, and induce the formation of periportal hepatocytes, which contain cavities. Compared with the development of normal liver, this study shows that the interaction between interstitial materials around portal vein may participate in the differentiation and remodeling of hilar bile duct, and the disorder of this process may lead to the occurrence of BA.
According to the color of newborn feces, it is estimated whether the baby has biliary atresia.
Symptoms of biliary atresia The main symptoms of biliary atresia are persistent jaundice, clay-colored feces, thick tea urine and hepatosplenomegaly. There was no significant change in children's nutritional development, height and weight in the first three months. Most babies are full-term, and there is no abnormality within 1 ~ 2 weeks after birth. Often, after physiological jaundice subsides, the sclera and skin turn yellow. With the increase of age, jaundice continues to deepen, and the color of urine also deepens, even showing a strong tea color. Some children's feces turn into white clay after birth, but there are also many children whose fetal feces and postnatal feces are normal. With the deepening of systemic jaundice, the color of feces gradually fades and eventually becomes white clay. About 15% of children will have white stools one month after birth. The feces of patients with long course of disease can change from white to light yellow. This is because the concentration of bilirubin in the blood is too high, and a small amount of bilirubin is discharged into the intestinal cavity through the intestinal gland and mixed with feces.
With the aggravation of jaundice, the liver gradually increases and hardens, and the abdominal distension in children is more obvious. The liver of a 3-month-old child can enlarge the umbilical cord, and the spleen can also be enlarged. After 3 months, growth slowed down, malnutrition, listlessness and anemia. After 5 ~ 6 months, the general condition deteriorated rapidly due to biliary obstruction, fat absorption disorder and lack of fat-soluble vitamins. Physical examination showed abdominal swelling, hepatomegaly, smooth surface, hard texture and blunt edge; In the late stage of intrahepatic cholestasis, hepatic fibrosis and biliary cirrhosis, symptoms of portal hypertension such as splenomegaly, abdominal varicose veins and ascites may appear, which will eventually lead to liver failure. Hepatic encephalopathy is often the direct cause of death. If the biliary tract cannot be reconstructed surgically, the general survival time is 1 year.
Examination and diagnosis of biliary atresia
At present, the following tests are considered to have certain diagnostic value.
1, blood biochemistry. Due to severe intrahepatic cholestasis, BA leads to liver injury, and its blood biochemistry will be obviously abnormal, mainly manifested in the abnormality of liver function index and bilirubin index. Analysis of blood biochemical indexes after birth is helpful to diagnose BA. By comparing the blood biochemical indexes of children with BA and neonatal hepatitis (NH), it is found that when the blood biochemical GGT/AST ratio exceeds 2, children are more prone to BA, and the sensitivity and specificity of GGT/AST exceeding 2 are 80.9% and 72.2% respectively. GGT & gt； The sensitivity, specificity and negative likelihood ratio of 250U/L in the diagnosis of BA were 83.3%, 70.6% and less than 2. When GGT level is related to age, the performance of GGT in the diagnosis of BA is improved, especially for children less than 4 weeks. The sensitivity, specificity and positive likelihood ratio of GGT >: 150 u/L are 9 1.7%, 88% and 7.8 respectively. Therefore, the blood biochemical GGT level is a reliable index for diagnosing BA.
2. Ultrasonic imaging examination. Ultrasound is a rapid and non-invasive examination method. As a widely used and simple examination method, it is especially suitable for screening and diagnosis of biliary atresia in children. The findings of hepatic portal triangle cable sign by abdominal ultrasound, the changes of gallbladder volume, shape and contraction function, the changes of liver size and texture, and even the changes of hepatic artery diameter are all considered as ultrasonic indications of BA, especially the hepatic portal triangle cable sign is the most sensitive.
The change of gallbladder is also a reference for the diagnosis of BA, in which the change of gallbladder length and contractile function is a diagnostic indication worthy of reference. Under BA ultrasound, the gallbladder abnormality is mainly characterized by absence of gallbladder, gallbladder cavity and gallbladder length less than 65438±0.5cm, and the gallbladder contraction abnormality is mainly characterized by low or no gallbladder contraction after eating, with an accuracy rate of 77%, a sensitivity of 85% and a specificity of 73%. In addition, because BA is usually accompanied by liver fibrosis, liver enlargement and uneven echo can be seen under BA liver ultrasound. The degree of hepatomegaly and uneven echo has nothing to do with age, but with the degree of liver fibrosis.
In a word, TC sign is a direct and specific objective criterion for diagnosing BA, but it is not the only criterion. The changes of gallbladder and the size and texture of liver are also important reference indexes for the diagnosis of BA.
3.99mt c- diethyliminodiacetic acid (DIDA) excretion test. In recent years, instead of 13 1 iodine, the extraction rate of hepatocytes is higher (48% ~ 56%), which is better than other projects. It can be used to diagnose some biliary obstruction caused by structural abnormalities, such as choledochal cyst or extrahepatic cholangiography stenosis. When the obstruction is complete, the intestinal development can not be seen by scanning, which can be regarded as severe intrahepatic cholestasis. In the early stage of biliary atresia, liver cells function well in 5 minutes, but there is no biliary tract development after that, and even no intestinal development after 24 hours. Neonatal hepatitis, although the function of liver cells is poor, but the extrahepatic biliary tract is unobstructed, so the intestine is developed.
4. quantitative determination of lipoprotein x. Lipoprotein -X is a kind of low-density lipoprotein, which rises when biliary obstruction occurs. According to the research, all cases of biliary atresia have increased significantly. Newborn hepatitis cases that are positive at a very young age are negative in the early stage, but they can also become positive with age. Biliary atresia can be ruled out if Lp-X is negative after birth for more than 4 weeks. If > 500mg/dl, the possibility of biliary atresia is high. You can also take cholestyramine 4g/ day for 2-3 weeks, and compare the indexes before and after taking it. If the content decreases, it will support the diagnosis of neonatal hepatitis syndrome, and if it continues to increase, it may lead to biliary atresia.
5. Quantitative determination of bile acids. Recently, when the bile duct was blocked with blood paper, the serum total bile acid was107 ~ 294 μ mol/L. Generally speaking, when it reaches 65438 000 μ mol/L, it is considered as cholestasis, while the jaundice-free control group of the same age is only 5 ~ 33 μ mol/L, with an average of 65438 08 μ mol/L, which has diagnostic value. Urinary bile acid is also an early screening method. The average urinary total bile acid of children with biliary atresia was19.93 7.53 μ mol/L, while that of the control group was1.60 0.16 μ mol/L, which was 0/0 times higher than that of normal children.
6. cholangiography. Cholangiography is the standard examination method to diagnose BA, because it can clearly show the structure of biliary tract. The examination can be performed by laparoscopy or open surgery. Because the examination is an open operation, once the diagnosis is made, Kasai operation can be performed, so many hospitals use open surgery for this examination. However, with the popularization and development of minimally invasive technology, laparoscopic-assisted cholangiography is gradually favored by the majority of pediatric surgeons. The advantages of laparoscopy-assisted cholangiography are simple, accurate, safe and minimally invasive, and it also avoids unnecessary surgery for children diagnosed as non-BA by cholangiography. With the popularization and application of laparoscopic Kasai surgery, laparoscopic-assisted cholangiography has increasingly become a common method to diagnose BA. By comparing the consistency between other diagnostic methods of BA and laparoscopic-assisted cholangiography, it was found that liver biopsy was 965,438 0.7%, ultrasound was 865,438 0.7%, hepatobiliary radionuclide angiography was 75%, and MRCP was 73%. It can be seen that cholangiography is the gold standard for the diagnosis of BA.
7. Pathological examination of liver puncture. Among various auxiliary examinations, liver biopsy is an invasive diagnostic method. However, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) advocates that liver biopsy should be used as a diagnostic examination method when infant cholestasis cannot be diagnosed. Liver biopsy is an important detection method to distinguish between Pakistani and infant idiopathic hepatitis. The accuracy, specificity and sensitivity of diagnosing BA were 100%, 95.7% and 100%. The pathological feature of infant idiopathic hepatitis is mainly the destruction of hepatocytes, while BA mainly shows the changes of biliary system, such as hepatobiliary duct hyperplasia, protein thrombosis in bile duct and hepatobiliary duct, hepatic portal fibrosis, etc. Among them, hepatobiliary duct hyperplasia is the most important indicator to distinguish BA from infant idiopathic hepatitis. In the early stage, infant idiopathic hepatitis and BA are very similar in clinical manifestations and blood biochemistry, so liver biopsy is a reliable detection method to distinguish them, and its accuracy rate can reach 96.9%. In addition, 17.9% BA liver biopsy showed abnormal development of bile duct plate.
To sum up, cholangiography is the gold standard for the diagnosis of BA, and laparoscopy has become a popular diagnostic method because of its minimally invasive and accuracy. In order to improve the chance of preoperative diagnosis of BA, ultrasound, as a non-invasive and widely used diagnostic technique, is particularly important to improve the diagnostic rate of BA. However, due to the influence of ultrasonic equipment and personnel quality, in recent years, with the update of equipment and the improvement of personnel quality, the accuracy of ultrasonic diagnosis of BA has been continuously improved. Liver biopsy is an important detection method to distinguish infant idiopathic hepatitis from hepatitis B, and the accuracy rate is over 80%. Ultrasound examination should be the first choice for children with persistent jaundice and suspected cholestasis after birth. If TC sign is found under ultrasound, it can be initially diagnosed as BA, and the child should be transferred to a hospital where BA surgery can be performed for further cholangiography, definite diagnosis and surgical treatment. If there is no TC sign under ultrasound, liver biopsy can be performed to improve the diagnostic rate of BA. If the diagnosis is still not confirmed, cholangiography can be used to confirm the diagnosis.
Treatment of biliary atresia
Surgical treatment of biliary atresia is the only way to treat biliary atresia. At present, Gexi operation and liver transplantation are widely used in the medical field to treat biliary atresia.
1, start operation
The treatment of BA can only be achieved by surgery, and Kasai surgery is usually used to restore normal bile flow to improve liver function and achieve long-term survival. Liver transplantation is the only treatment if the jaundice cannot be resolved by surgery or biliary cirrhosis occurs after surgery.
Gersey's surgery can be divided into open surgery and laparoscopic surgery. Open surgery is a traditional Kasai surgery, which has been widely used in the surgical treatment of BA, while laparoscopic Kasai surgery is mainly used in a few pediatric surgery centers because of its high technical requirements.
EstevesE first used laparoscopic Kasai to treat children with BA in 2002. With the popularization and application of laparoscopic technique, this technique is gradually recognized by people, but the curative effect of laparoscopic surgery is still controversial. Compared with open Kasai surgery, laparoscopic surgery has more postoperative complications and poor early prognosis. It is considered that laparoscopic surgery should be used cautiously in the treatment of BA. However, most studies believe that laparoscopic surgery for BA is safe, feasible and effective, and there is no difference between laparoscopic surgery and open surgery in terms of operation time, postoperative intestinal function recovery, hospitalization time, complications and subsequent liver transplantation requirements.
Compared with traditional Kasai surgery, laparoscopic surgery has specific advantages (less injury and faster postoperative recovery), which can better expose the hilum without moving the liver during the operation, make the tissues of the hilum free, make the anastomosis more accurate, and facilitate postoperative recovery. Laparoscopic surgery will lead to different therapeutic effects due to different operating skills of doctors, which may be one of the important reasons for the different therapeutic effects of laparoscopic treatment of biliary atresia. However, the advantages of laparoscopic surgery, such as less trauma and quick recovery, have been recognized by most scholars. Whether it can improve the long-term prognosis of biliary atresia needs further observation and research.
2. Liver transplantation
BA is a common indication of liver transplantation in children, accounting for more than 50% of all liver transplantation in children. In the past 20 years, due to the successful application of liver transplantation in the treatment of BA in children, the demand for liver transplantation in children has increased significantly. Therefore, the following liver transplantation techniques are widely used: reduced size liver transplantation, split liver transplantation and living donor liver transplantation. It is found that the survival rate of BA children after liver transplantation has nothing to do with the age of operation and the history of Kasai operation. The graft survival rate of split liver transplantation is the highest, and the overall survival rate of reduced-size liver transplantation is the lowest. Infants and young children are light in weight, and the volume of donor liver is small, so it is necessary to reduce the volume, including split donor liver and living donor liver. The source of cadaveric donor liver is increasingly scarce, and living donor liver is more worth promoting. Because:
1) expanded the source of donors;
2) Living donor liver transplantation is mostly an elective operation. Donors and recipients can make full preparations for liver transplantation before the child's condition deteriorates, so as to reduce the mortality rate of recipients waiting for liver transplantation;
3) reduce the cold ischemia time of donor liver, thus improving the quality of donor liver;
4) Before operation, the donor can be examined by CT, MRI, etc., which is helpful to select the volume according to the best proportion, so that the transplanted liver can match the recipient better, and it is beneficial to vascular reconstruction to understand the anatomical factors such as blood vessels through various examinations before operation;
5) According to the analysis results of ABO blood group, leukocyte antigen and HLA, a more suitable donor-recipient histocompatibility matching can be obtained;
6) It helps to realize the family psychological effect, so that the parents of children can get the chance to save their lives through living donor liver transplantation.
Nursing points of biliary atresia
How to nurse biliary atresia We should pay attention to careful nursing before and after operation and in daily life.
1, preoperative intestinal preparation. Preoperative intestinal preparation is necessary for children with BA to reduce intestinal biofouling and reduce the chance of postoperative cholangitis. Preoperative intestinal irrigation 1-2 times 1 d, usually with normal saline at low pressure. Do not use soapy water, lest the alkaline environment of the intestine increase the absorption of ammonia, thus increasing the burden on the liver. The total amount of intestinal lavage fluid is 80- 1.20 ml/kg, and special attention should be paid to keep warm during intestinal lavage to avoid respiratory tract infection caused by cold in children and delay the operation opportunity. Mechanical irrigation can be used before operation to reduce the number of intestinal microorganisms.
2. Nursing care of postoperative incision. Most children with BA have abnormal liver function, liver cirrhosis and even abdominal distension caused by ascites before operation. Postoperative wound healing is worse than other children, and ascites often extravasates through surgical incision. Change the dressing in time, keep the incision dry, and prevent the wound from infection and dehiscence.
3, closely observe the changes in the condition. The observation contents include body temperature, pulse, respiration, mental state, jaundice changes, abdominal distension and so on. Because most children with BA are complicated with umbilical hernia, sometimes whether the contents of umbilical hernia are prominent is an objective index to observe the degree of abdominal distension. Severe abdominal distension can be regarded as the manifestation of abnormal aggravation of liver function. Attention should be paid to the differentiation from postoperative intestinal obstruction. In addition, it is also important to observe the changes of jaundice after operation. When the intrahepatic bile duct is opened after operation, bile is discharged from the bile duct into the intestine, indicating that bile enters the normal enterohepatic circulation. At this time, the child's jaundice will be relieved. The color of skin and urine becomes lighter, and the color of stool changes from clay to green or yellow, which are all signs of improvement.
4. Basic nursing. To keep the oral cavity clean, it is necessary to feed a small amount of warm water to remove the residual milk after feeding. Patients with thrush should clean their oral cavity with normal saline after feeding. Clean the skin with warm water to avoid damaging the protective layer of the skin.
5. Observation and nursing of complications. There are many postoperative complications in children with bronchial asthma, among which cholangitis and double infection are the most common in the early stage.
(1) Cholangitis is the most common, most difficult to treat and seriously affects the prognosis after hepaticojejunostomy. Its incidence rate is as high as 80%, which can quickly block the newly established small bile duct due to inflammatory reaction and scar, so it needs early treatment and prevention. Its manifestations include unexplained irritability, crying, fatigue, abdominal distension, and deepening jaundice. Bile excretion is reduced or stopped, severe cases are accompanied by chills and fever, serum bilirubin is increased again, and white blood cells are obviously increased. After cholangitis, two or more antibiotics should be used in combination. The application of hormone can reduce tissue edema, inhibit collagen deposition, accelerate the excretion of liver cholestasis and help jaundice subside. To improve the quality of life of postoperative children. Increase the life of autologous liver. But at the same time, it also leads to the decline of children's resistance, so visitors should be strictly restricted in nursing. Don't share a room with children with infectious diseases, especially respiratory infections. Pay attention to implementing protective isolation. At present, it is considered that food reflux is an important cause of cholangitis. Therefore, the baby should be held vertically for more than 30min after feeding to reduce food reflux.
(2) The related factors of double infection include decreased resistance, long-term use of antibiotics and hormone therapy. There are many inducing factors in children with biliary atresia. Its manifestations are superficial or deep fungal infections, such as candida infection, thrush and fungal cholangitis, which are difficult to diagnose and treat.
Experts say that the surgical age of children with biliary atresia is an important factor to determine their prognosis. Generally, the effect of surgical treatment is better within 60 days after birth. Therefore, once children are found to have skin and scleral jaundice, white stool and dark yellow urine, and long-term use of cholagogic and jaundice-removing drugs is ineffective, they should go to children's specialist hospitals in time, especially large-scale children's specialist hospitals, which specialize in pediatric surgery. If necessary, the diagnosis should be made by laparoscopic cholangiography to avoid delaying the treatment opportunity.
Compared with Dai Joni (more than 3 months), there is still some controversy about whether surgery is needed. However, the latest research found that the age at the time of operation is not a bad prognosis. For older children with better liver condition, some children still have better prognosis after the card game. However, parents of children who are going to undergo Gersey's surgery should be fully prepared before surgery. Because a large proportion of children after Gexi have poor prognosis because of cholangitis attack and liver function damage.