嬰兒稽延性阻塞性黃疸之研究(I)臨床觀察及各種實驗室檢查、計分法與肝針刺活體切片之評估

During the period from August, 1977 to February, 1983, 124 infants admitted with prolonged obstructive jaundice reached the final diagnosis either by laparotomy, autopsy or clinical follow-up. The clinical data of 24 cases of biliary atresia and 77 cases of idiopathic neonatal hepatitis were compared and analyzed. The results were: (1) In comparison with idiopathic neonatal hepatitis, cases of biliary atresia were more likely to have patterns of jaundice persisting from neonatal jaundice (83.3% vs. 52%, P＜0.01), typical clay color stool (83.3% vs. 42.9%, P＜ 0.01), hepatomegaly (54.2% vs. 22.1%, P＜0.01) and palpable spleen (66.7% vs. 16.9%, P＜0.01). (2) Cases of biliary atresia had higher levels of total serum bilirubin (13.7+5.9mg/dl vs. 7.2+3.2mg/dl, P＜0.001) and direct bilirubin (8.6±3.4mg/dl v. s. 4.7±1.8mg/dl, P＜0.001), and most of them were always higher than 8 mg/dl and 5 mg/dl respectively. (3) For the diagnosis of biliary atresia, the sensitivity of Schmidt's test was 95.5%, its specificity 43.6% and its accuracy 57.7%. (4) The sensitivity of the test to demonstrate the absence of bile-stain in duodenal juice aspirated for the diagnosis of biliary atresia was 100%, its specificity 70%, and its accuracy 79.3%. (5) Using our score method which was a modification of Chiba's (1974), 10 out of 12 cases of biliary atresia had score higher than 5 (including 5) and 30 out of the 36 cases of idiopathic neonatal hepatitis had score lower than 0 (including 0). Thus, its accuracy was 83.3%. (6) The accuracy of diagnosis by liver needle biopsy was 75%.