CAJ | 학술논문

目的：探讨腹腔镜下胆道探查联合术中快速冰冻切片肝活检对胆道闭锁的诊断价值。方法在腹腔镜胆道探查术中同时剪取肝边缘少量肝组织，送快速冰冻切片活检，并将肝组织内病理形态改变与术后石蜡切片进行比较研究。结果2012年9月至2013年12月作者收治57例梗阻性黄疸患儿，全部经腹腔镜探查、胆道造影、术中冰冻切片肝活检联合诊断，其中胆道闭锁55例，胆汁淤积症2例。术中冰冻切片与术后石蜡切片对比，两者对肝纤维化、胆管增生程度、BA 分级等判断一致性高（Kappa 值分别为0．675、0．871、0．775）；但冰冻切片对汇管区及肝小叶炎性细胞浸润观察效果较差， Kappa 值为0．309，差异有统计学意义。结论术中肝组织冰冻切片与腹腔镜探查、胆道造影及术后石蜡切片相对照符合率高，能够准确判断肝脏纤维化以及小胆管增生程度，有助于胆道闭锁的术中诊断及预后评估。
목적：탐토복강경하담도탐사연합술중쾌속빙동절편간활검대담도폐쇄적진단개치。방법재복강경담도탐사술중동시전취간변연소량간조직，송쾌속빙동절편활검，병장간조직내병리형태개변여술후석사절편진행비교연구。결과2012년9월지2013년12월작자수치57례경조성황달환인，전부경복강경탐사、담도조영、술중빙동절편간활검연합진단，기중담도폐쇄55례，담즙어적증2례。술중빙동절편여술후석사절편대비，량자대간섬유화、담관증생정도、BA 분급등판단일치성고（Kappa 치분별위0．675、0．871、0．775）；단빙동절편대회관구급간소협염성세포침윤관찰효과교차， Kappa 치위0．309，차이유통계학의의。결론술중간조직빙동절편여복강경탐사、담도조영급술후석사절편상대조부합솔고，능구준학판단간장섬유화이급소담관증생정도，유조우담도폐쇄적술중진단급예후평고。
Objetive To investigate the clinical application value of laparoscopic cholangiogram explora-tion combined intraoperative liver biopsy in diagnosis and treatment of infants with obstructive jaundice.Meth-ods In laparoscopic cholangiogram exploration,a small amount of liver tissue was sheared,then the quick fro-zen biopsy was got to assist the diagnosis,and the result was compared with postoperative pathology of paraffin section.Results 57 children with obstructive jaundice treated in our hospital between September 2012 and December 2013 underwent laparoscopic exploration,biliary cholangiography and intraoperative liver biopsy,55 cases were diagnosed as biliary atresia,and 2 cases cholestasis.According to the contrast of the intraoperative frozen section and postoperative paraffin section,both the degree of liver fibrosis and bile duct hyperplasia judg-ment is highly consistent(Kappa =0.675、0.871 、0.775),but inflammation in the hepatic lobule and portal ar-ea of frozen section is poorer(Kappa =0.309),the difference is statistically significant.Conclusions Intrao-perative liver biopsy combined laparoscopic exploration,biliary cholangiography is highly coincident with post-operative pathology,which can help get accurate judgment of the liver fibrosis degree and small bile duct hyper-plasia,and get diagnosis and pre -evaluation.