肝门空肠吻合术对胆道闭锁的近中期疗效及其影响因素分析  

Analysis of the short-and mid-term curative effect and influence factors of hepaticojejunostomy for biliaryatresia

作　　者：曲修水[1] 张文倩[1] 李玉春 

机构地区：[1]滨州市人民医院小儿外科,山东省滨州256610 [2]山东省利津县北宋医院小儿外科

出　　处：《中国基层医药》2013年第18期2755-2757,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨肝门空肠吻合术（Kasai术）对胆道闭锁的近中期疗效及其影响因素。方法回顾性分析62例行Kasai术胆道闭锁患儿的临床资料。分析患儿黄疸消退率、2年自体肝存活率和影响预后的因素。结果62例患儿术后黄疸消退率为58．1％，2年自体肝存活率为53．2％。其中Ⅰ、Ⅱ、Ⅲ型患儿黄疸消退率、2年存活率的差异均无统计学意义（X^2=1．91、0．76，均P〉0．05）。60d内手术的2年自体肝存活率明显高于61-90d、90d后手术的（X^2=4．72，P〈0．05）。感染巨细胞病毒以及术后并发胆管炎的患儿2年自体肝存活率分别为43．6％、39．5％，明显低于非感染感染巨细胞病毒以及未并发胆管炎患儿的69．6％、75．0％（X^2=3．92、7．46，均P〈0．05）。结论Kasai手术仍是治疗胆道闭锁的首选方法，患儿的疾病分型与Kasai术后近中期疗效没有明显关系，手术年龄则是影响预后的主要因素。因此，做到及早手术、加强抗病毒治疗以及术后防治胆管炎尤为重要。Objective To explore the short-and mid-term curative effect and influence factors of hepatieoje- junostomy（ Kasai operation） for biliary atresia. Methods The clinical data of 66 children with biliary atresia treated with Kasai operation were analyzed retrospectively. The jaundice fading rate,2-year survival rate and influence factors of prognostic were analyzed. Results The jaundice fading rate of 62 eases was 58.1% after Kasai operation. The pa- tients also had a 2-year native liver survival rate of 53.2%. The jaundice fading rate,2-year survival rate of type Ⅰ、Ⅱ and Ⅲ had no significant differences （ X^2= 1.91,0.76, all P 〉 0. 05 ）. The 2-year survival rate of children under- went Kasai operation as younger than 60 days was higher rate than that of the children as 61 to 90 days and older than 90 days（X^2 =4.72 ,P 〈0.05 ）. The 2-year survival rate of children with cytomegalovirus infection and postoperative cholangitis were 43.6% ,39.5%, respectively, which were lower than those of children without eytomegalovirus infec- tion and postoperative cholangitis （69.6% ,75.0% ） （ X^2= 3.92,7.46, all P 〈 0.05 ）. Conclusion Kasai operation is still the preferred method for the treatment of biliary atresia. Type of the disease was not related with the short-and mid-term effects of Kasai operation. Age at operation was the main factor affecting the prognosis. Therefore, it is very important to make early surgery, enhance the anti-viral treatment and prevent postoperative eholangitis.

关 键 词：胆道闭锁 肝门空肠吻合术 治疗结果 

分 类 号：R726.5[医药卫生—儿科]