胆道闭锁Kasai术后胆管炎的诊治及预后研究  

Diagnosis, management and prognosis of post-Kasai cholangitis

作　　者：庞文博[1] 陈亚军[1] 张廷冲[1] 彭春辉[1] 王增萌[1] 吴东阳[1] 张丹[1] 严佳虞 沈秋龙[1] 王凯[1] Pang Wenbo;Chen Yajun;Zhang Tingchong;Peng Chunhui;Wang Zengmeng;Wu Dongyang;Zhang Dan;Yan Jiayu;Shen Qiulong;Wang Kai(Department of General Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院普外科,北京100045

出　　处：《临床小儿外科杂志》2022年第1期41-45,共5页Journal of Clinical Pediatric Surgery

基　　金：中国工程院-外科扶持基金;北京市医院管理中心“青苗”计划专项经费资助(QML20191205)。

摘　　要：目的总结胆道闭锁Kasai术后胆管炎的诊治经验,并分析其长期预后。方法采用回顾性研究方法,收集2008年6月至2017年6月首都医科大学附属北京儿童医院普外科收治的66例胆道闭锁Kasai手术后胆管炎患儿临床资料,根据初次胆管炎发作时初始治疗用药情况分为头孢哌酮舒巴坦组(17例)、美罗培南组(12例)以及亚胺培南西司他丁钠组(37例),根据治疗后有无复发分为复发组(15例)、无复发组(51例)。按照不同分组方法进行疗效(初次胆管炎疗效)及远期预后(胆管炎治愈率和5年自体肝生存率)的评估与比较。结果头孢哌酮舒巴坦组、美罗培南组和亚胺培南西司他丁钠组三组胆管炎患儿经初始用药治疗后有效率分别为41.2%、75.0%和89.2%,差异有统计学意义(χ^(2)=14.046,P=0.001),两两比较结果显示,亚胺培南西司他丁钠组有效率明显高于头孢哌酮舒巴坦组(89.2%vs.41.2%,χ^(2)=13.982,P<0.001)。就远期预后而言,复发组总体治愈率较无复发组低(40.0%vs.88.2%,χ^(2)=15.356,P<0.001),无复发组5年自体肝生存率明显优于复发组(82.8%vs.41.5%,χ^(2)=7.993,P=0.005)。结论早期优化胆道闭锁Kasai手术后胆管炎的治疗,有利于实现患者远期自体肝生存,Kasai手术后胆管炎发作可首选亚胺培南西司他丁钠抗感染治疗,多次发作胆管炎对患者预后不利。Objective To summarize the experience in the diagnosis and treatment of cholangitis after Kasai operation in children with biliary atresia,and analyze its longterm prognosis.Methods A retrospective study was performed on the clinical data of 66 cholangitis patients after Kasai operation from June 2008 to June 2017.The patients were categorized into CefoperazoneSulbactam group(n=17),Meropenem group(n=12)and Imipenem-Cilastatin Sodium group(n=37)according to the initial medication at the onset of primary cholangitis.and recurrence group(n=15)and nonrecurrence group(n=51)based on the recurrence of cholangitis after treatment.The efficacy(primary cholangitis efficacy)and long-term prognosis(cure rate of cholangitis and 5-year survival rate of native liver)were compared between each group.Results The effective rates of the three initial medication groups were significantly different(41.2%vs.75.0%vs.89.2%;χ^(2)=14.046,P=0.001),and Imipenem-Cilastatin Sodium group was obviously more effective than Cefoperazone-Sulbactam group(89.2%vs.41.2%;χ^(2)=13.982,P<0.001).Compared with recurrence group,the non-recurrence group has higher cure rate of cholangitis in terms of long term prognosis(40.0%vs.88.2%;χ^(2)=15.356,P<0.001)and native liver survival rate(82.8%vs.41.5%;χ^(2)=7.993,P=0.005).Conclusion Early optimal management of postKasai cholangitis will help to maintain the native liver survival in the long term.ImipenemCilastatin Sodium can be the first choice of medication for recurrent postKasai cholangitis.Recurrence of cholangitis will expert adverse effects on patients'prognosis.

关 键 词：胆道闭锁/外科学 胆管炎/诊断 胆管炎/治疗 预后 

分 类 号：R726.5[医药卫生—儿科]