活体肝移植治疗胆道闭锁儿童临床疗效研究  

Clinical efficacy of living donor liver transplantation for treatment of Children with biliary atresia

作　　者：常青锋 王静 宋翠萍[2] Chang Qingfeng;Wang Jing;Song Cuiping(Department of Pediatric Surgery,Children's Hospital,Anyang 455000,Henan Province,China)

机构地区：[1]河南省安阳市儿童医院/妇幼保健院小儿外科,455000 [2]新乡医学院第一附属医院小儿外科

出　　处：《实用肝脏病杂志》2021年第3期431-434,共4页Journal of Practical Hepatology

基　　金：河南省新乡市科技计划项目(编号:CXGG17006)。

摘　　要：目的分析比较采用Kasai术后肝移植术或直接肝移植术治疗胆道闭锁(BA)儿童的临床疗效。方法2010年9月~2016年10月我科收治的BA儿童74例,其中在Kasai术后接受活体肝移植治疗38例,直接行活体肝移植治疗36例,随访3年。采用Kaplan-Meier生存分析。结果序贯组接受活体肝移植时中位月龄为12.5(5.8,72.5)个月,显著大于肝移植组[7.2(5.8,36.8)个月,P<0.05],体质量为(12.8±5.2)kg,显著大于肝移植组[(10.2±6.6)kg,P<0.05],术前血清胆红素水平为158.4(20.4,500.8)μmol/L,显著低于肝移植组[250.9(60.8,468.0)μmol/L,P<0.05],儿童终末期肝病模型(PELD)评分为(12.5±9.6),显著低于肝移植组[(20.8±15.4),P<0.05],两组移植物质量、供肝质量与受体体质量比(GRWR)、热缺血时间、冷缺血时间、术中失血量和术中输血量等无显著性差异(P>0.05);在活体肝移植术后,肝移植组患儿并发症发生率为55.6%(20/36),显著低于序贯组[68.4%(26/38),P<0.05];在术后1 m、1 a和3 a,序贯组累积生存率为97.3%(37/38)、94.7%(36/38)和89.5%(34/38),肝移植组分别为97.2%(35/36)、91.7%(33/36)和86.1%(31/36),两组之间无显著性差异(P>0.05)。结论对于BA患儿,可考虑直接接受活体肝移植手术治疗,以获得较好的临床结局。Objective The aim of this study was to investigate the clinical efficacy of living donor liver transplantation(LDLT)for treatment of Children with biliary atresia(BA).Methods 74 children with BA were recruited in our hospital between September 2010 and October 2016,and 36 children underwent LDLT,and 38 children received LDLT after Kasai failure.All the children were followed-up for 36 months.The Kaplan-Meier survival analysis was applied to compare the cumulative survival rate between the two groups.Results The median age in children receiving LDLT after Kasai was 12.5(5.8,72.5)months,significantly older than 7.2(5.8,36.8)months(P<0.05)in children receiving LDLT directly,the weight was(12.85.2)kg,significantly higher than(10.2±6.6)kg(P<0.05)in children receiving LDLT directly,the preoperative serum bilirubin level was 158.4(20.4,500.8)μmol/l,significantly lower than 250.9(60.8,468.0)μmol/l(P<0.05)in children receiving LDLT directly,the pediatric end-stage liver disease(PELD)score was(12.5±9.6),significantly lower than[(20.815.4),P<0.05]in children receiving LDLT directly,while there were no significant differences in graft quality,donor liver weight to recipient weight ratio(GRWR),hot ischemia time,cold ischemia time,intraoperative blood loss and intraoperative blood transfusion between the two groups(P>0.05);the incidence of post-operative complications in children receiving LDLT was 55.6%(20/36),significantly lower than[68.4%(26/38),P<0.05]in children underwent LDLT after Kasai;the 1-month,1-year and 3-year cumulative survival rates in children receiving LDLT after Kasai were 97.3%,94.7%and 89.5%,not significant different as compared to 97.2%,91.7%and 86.1%in children receiving LDLT directly(P>0.05).Conclusion We recommend based on our results that the LDLT should be directly given in children with BA,which might obtain a better outcomes in future.

关 键 词：胆道闭锁 活体肝移植术 Kasai术 Kaplan-Meier生存分析 

分 类 号：R726.5[医药卫生—儿科]