Kasai术中肝脏吲哚菁绿显像特点与胆道闭锁患儿早期预后的关系探索  

Study of real-time imaging with indocyanine green during hepatoportoenterostomy as a prognostic factor in children with biliary atresia

作　　者：徐琛 汤悦 郑珊[1] 黄焱磊[1] 杨少波[1] 孙松[1] 李军[1] 朱叶 刘源鑫 宋再[1] 董晨彬[1] 陈功[1] Xu Chen;Tang Yue;Zheng shan;Huang Yanlei;Yang Shaobo;Sun Song;Li Jun;Zhu Ye;Liu Yuanxin;Song Zai;Dong Chenbin;Chen Gong(National Children's Medical Center(shanghai),Children's Hospital of Fudan University,Department of Pediatric Surgery,Shanghai 201102;National Children's Medical Center(Shanghai),Children's Hospital of Fudan University,Department of Neurosurgery,Shanghai 201102;National Children's Medical Center(Shanghai),Children's Hospital of Fudan University,Department of Anesthesiology,Shanghai 201102;National Children's Medical Center(Shanghai),Children's Hospital of Fudan University,Department of Medical Ultrasonography,Shanghai 201102,China)

机构地区：[1]国家儿童医学中心,复旦大学附属儿科医院外科,上海201102 [2]国家儿童医学中心,复旦大学附属儿科医院神经外科,上海201102 [3]国家儿童医学中心,复旦大学附属儿科医院麻醉科,上海201102 [4]国家儿童医学中心,复旦大学附属儿科医院超声科,上海201102

出　　处：《临床小儿外科杂志》2022年第8期738-745,共8页Journal of Clinical Pediatric Surgery

基　　金：上海市临床重点专科(shslczdzk05703);国家儿童医学中心“登峰”交叉创新团队(EK112520180211);医苑新星杰出青年医学人才2018(EK00000622);上海市科委西医引导项目(No.18411969100);国家自然基金面上项目(No:81873545)。

摘　　要：目的本研究探索在Kasai术中使用ICG后的肝脏荧光显像特点与胆道闭锁早期预后的关系。方法本研究纳入2019年11月至2020年5月在复旦大学附属儿科医院外科行胆道探查与Kasai手术的Ⅲ型胆道闭锁患儿共87例,其中男38例,女49例,手术日龄(60.49±20.75)d,体重(4.83±0.76)kg。术前1天注射ICG。术中用近红外摄像系统观察肝门部及肝脏表面ICG荧光显像特点,计算相应部位的亮度值。根据肝门部显像快慢(快显像为ⅰ组,慢显像为ⅱ组,不显像为ⅲ组)、肝脏表面荧光特征(点状荧光为A组,均匀强荧光为B组,均匀弱荧光为C组)以及肝门部亮度比值比分别进行亚组分析,比较各组胆汁排泄速度、胆汁分布及瞬时胆汁流量与早期预后的关系。早期预后指标为术后3个月、6个月退黄率及术后1年自体肝生存率。结果87例患儿术后3个月、6个月总体退黄率分别为49.4%和59.8%,术后1年自体肝生存率为59.8%。其中ⅰ组(n=66)、ⅱ组(n=5)和ⅲ组(n=16)术后6个月退黄率分别为62.1%(41/66)、60%(3/5)和50%(8/16)(χ^(2)=0.929,P=0.679),ⅱ组术后1个月内各时间点(术后7天、14天、1个月)的血清胆红素数值与术前相似,但三组患儿术后6个月内胆红素总体下降趋势比较差异无统计学意义(P=0.0641)。A组(n=33),B组(n=40)和C组(n=14)术后6个月退黄率分别为41/66、3/5和8/16,(χ^(2)=0.299,P=0.876),组间术后6个月内退黄趋势比较差异无统计学意义(P=0.923)。肝门部亮度比值比与术后6个月退黄无关(P=0.432)。结论Ⅲ型胆道闭锁Kasai术中胆汁排泄慢的患儿黄疸消退需要更长时间,术中使用ICG检测肝门胆汁排泄速度、胆汁分布及瞬时胆汁流量结果与术后BA患儿早期退黄和生存情况无明显相关性。Objective Indocyanine green(ICG)facilitates real-time imaging of bile outflow during Kasai procedure.This study was to explore the relationship between the characteristics of liver fluorescent imaging during Kasai with ICG and early prognosis of children with biliary atresia(BA).Methods From November 2019 to May 2020,87 children with typeⅢBA undergoing ICG-FCG were retrospectively reviewed.There were 38 boys and 49 girls with an operative age of(60.49±20.75)day and an average weight of(4.83±0.76)kg.Porta hepatis(PH)and liver were examined intraoperatively with a near-infrared camera system and lightness values of special sites calculated for further analysis.For seeking the potential correlation between ICG-FCG and outcome,(ⅰ)enhanced imaging,(ⅱ)delayed imaging and(ⅲ)stable imaging were sub-grouped by dynamic images of PH;(A)spotty fluorescence;(B)diffuse strong fluorescence;(C)diffuse weak fluorescence based upon fluorescent patterns of liver surface.Ratio of lightness ratio of PH was calculated and the relationship was compared between bile excretion,bile distribution and transient bile flow and early prognosis in each group.The early endpoints were the 3/6-month postoperative jaundice clearance rate(JCR)and 1-year native liver survival rate(NLS).Results The overall JCR at Month 3/6 were 49.4%and 59.8%respectively and 1-year NLS was 59.8%.There were groupⅰ(n=66),groupⅱ(n=5)and groupⅲ(n=16)and JCR at Month 6 was 62.1%(41/66)、60%(3/5)and 50%(8/16)respectively(χ^(2)=0.929,P=0.679).In group ii,direct bilirubin was similar to preoperative levels at Week 1/2/4 post-operation and ultimately it attained the same low-level as two other groups at Month 6.The overall data revealed no difference in declining rate of bilirubin(P=0.0641)among the group A(n=33),group B(n=40)and group C(n=14).And JCR at Month 6 was 57.6%,62.5%and 57.1%respectively(χ^(2)=0.299,P=0.876).There was no difference in declining rate of bilirubin among three groups(P=0.923).Ratio of lightness ratio of PH was not correlated with 6-m

关 键 词：胆道闭锁/诊断 胆道闭锁/外科学 荧光染料 吲哚菁绿 预后 预测 

分 类 号：R725.7[医药卫生—儿科]