胆道闭锁肝门肠吻合术手术改进的初步探讨  

Clinical efficacy of modified portoenterostomy for biliary atresi

作　　者：董淳强[1] 董昆[1] 杨体泉[1] 

机构地区：[1]广西医科大学第一附属医院小儿外科,南宁530021

出　　处：《中华小儿外科杂志》2016年第1期53-58,共6页Chinese Journal of Pediatric Surgery

基　　金：广西壮族自治区卫生厅计划课题（Z2014026）

摘　　要：目的对胆道闭锁（BA）肝门肠吻合术（PE）进行手术改进并评价治疗效果。方法对2012年3月至2014年2月进行PE的III型BA病例的临床资料进行回顾性分析。本研究病例的PE方式分为扩大肝门部病变切除范围PE手术（EPE）、Nakamura的Kasai改进手术（MKPE）和本研究的改进Kasai手术（OMKPE）3种并根据PE方式将病例分组。对病例的术前临床资料、术后黄疸清除率、胆管炎发作率和自体肝生存率按PE方式分组比较，并按不同手术年龄（≤90d和〉90d两组）再进行组间比较。结果87例获得完整随访，其中EPE34例，MKPE19例，OMKPE34例。各组手术年龄、体重、术前肝功能指标、肝外胆管Ohi亚型和术中肝纤维化Weerasooriya分级比较均无统计学差异（P〉0．05）。OMKPE的术后黄疸清除率和自体肝生存率为73．5％和73．5％高于EPE的38．2％和38．2％（P〈0．05），但MKPE的为57．9％和58．9％，与OMKPE和EPE比较，差异无统计学意义（P〉O．05），其中≤90d手术年龄组中OMKPE的术后黄疸清除率和自体肝生存率为90．9％和90．9％以及MKPE的为90％和90％，高于EPE的46．2％和38．5％（P〈0．05），但OMKPE与MKPE比较，差异无统计学意义（P〉0．05），〉90d手术年龄组中OMKPE的术后黄疸清除率和自体肝生存率为65．2％和65．2％，高于MKPE的22．2％和22．2％以及EPE的12．5％和12．5％（P〈0．05）但MKPE与EPE比较，差异无统计学意义（P〉0．05）。胆管炎发作率各组比较差异无统计学意义（P〉0．05）。结论对比EPE和MKPE，OMKPE手术更有利于提高BA术后黄疸清除率和延长自体肝生存，尤其适用于〉90d大龄患儿。Objective To explore the clinical efficacy of modified portoenterostomy （PE） for biliary atresia （BA）. Methods The BA （type Ⅲ ） patients undergoing PE from March 2012 to February 2014 are retrospectively analyzed. Based upon the types of PE, they were divided into three groups of extended portoenterostomy （EPE）, Nakamura＇s modified Kasai portoenterostomy （MKPE） and modified Kasai portoenterostomy （OMKPE） respectively. Their demographic characteristics, rate of jaundice free （JF）, incidence of cholangitis （CO） and survival rate of native liver （SNL） were compared. And the same profiles were compared according to operative duration （490 d and 〉90 d）. Results A total of 87 cases obtained a complete follow-up and the cases of EPE, MKPE, OMKPE were 34, 19 and 34 respectively. No significant difference existed in age, weight and preoperative indices of liver function. Ohi subtype of extrahepatic bile duct and Weerasooriya＇s grade of liver fibrosis showed no inter-group differences （P〉0. 05）. JF and SNL were higher in OMKPE than those in EPE （73.5%, 73. 5% vs. 38. 2%, 38. 2%, P〈0. 05）. No difference existed in MKPE （57. 9%, 58. 9%） versus OMKPE and EPE （P〈0. 05）. In group of operative duration 490 d, JF and SNL were higher in OMKPE （90. 9%, 90. 9%） and MKPE （90%, 90%） than EPE （46. 2%, 38. 5%） （P 〈0. 05） but not for MKPE versus OMKPE （P〉0. 05）. In group of operative duration 〉90 d, the highest JF ratio and SNL were found in OMKPE （65.2%, 65.2%） （P〈0. 05） and no difference between MKPE （22. 2%, 22. 2%） and EPE （12. 5%, 12. 5%） （P〈0. 05）. And CO showed no difference among three groups （P〉0. 05）. Conclusions Compared with EPE and MKPE, OMKPE is more efficient in clearing jaundice and boosting survival rate of native liver, especially for cases with operative duration 〉90 d.

关 键 词：胆道闭锁 吻合术 存活率 

分 类 号：R726.5[医药卫生—儿科]