基于病案首页信息的多中心胆道闭锁诊疗现况调查  

Current status of diagnosing and treating biliary atresia children based upon first page data of inpatient medical record: a multi-center cross-sectional study

作　　者：王增萌[1] 陈亚军[1] 王心雨 彭春辉[1] 吴东阳[1] 曾跃萍[3] 田剑[3] 彭晓霞[4] 福棠儿童医学发展研究中心(FRCPD) Wang Zengmeng;Chen Yajun;Wang Xinyu;Peng Chunhui;Wu Dongyang;Zeng Yueping;Tian Jian;Peng Xiaocia;Futang Research Center of Pediatric Development(Department of General Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Big-data Center,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Medical Record Center,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Center for Clinical Epidemiology&Evidence-based Medicine,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;不详)

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 [2]国家儿童医学中心,首都医科大学附属北京儿童医院大数据中心,北京100045 [3]国家儿童医学中心,首都医科大学附属北京儿童医院病案科,北京100045 [4]国家儿童医学中心,首都医科大学附属北京儿童医院临床流行病与循证医学中心,北京100045 [5]不详

出　　处：《中华小儿外科杂志》2023年第4期313-318,共6页Chinese Journal of Pediatric Surgery

基　　金：北京市医院管理中心"青苗"计划专项经费(QML20191205)。

摘　　要：目的:了解目前国内住院治疗的胆道闭锁患儿诊疗现况,调查患儿的基线信息、治疗方式选择和近年来住院治疗胆道闭锁患儿Kasai手术比例的变化趋势。方法:基于国内23家儿童专科医院的病案首页信息,调查出院日期为2016年1月1日至2019年12月31日,主要诊断为ICD-10编码"Q44.2胆管闭锁"患儿的信息,排除入院年龄大于180 d及再次入院的患儿信息,描述患儿的性别比例、入院年龄和治疗方式选择情况,比较不同年龄组患儿治疗方式选择的差异,分析近年来Kasai手术比例的变化趋势。结果:共纳入国内23家儿童专科医院2471例住院治疗的胆道闭锁患儿病案首页信息。男1154例(46.7%,1154/2471),女1317例(53.3%,1317/2471);中位入院年龄为55 d,范围在43~72 d。1417例(57.3%,1417/2471)患儿接受了Kasai手术,445例(18.0%,445/2471)患儿仅做了胆道探查手术,609例(24.6%,609/2471)未做任何手术。入院年龄为21~100 d的患儿Kasai手术比例(60.8%,1328/2183)高于0~20 d组(37.9%,33/87)和101 d以上组(27.9%,56/201)(P<0.001)。2016年至2019年患儿选择Kasai手术比例逐渐增高(45.2%增至72.3%),选择仅探查或不手术的比例逐渐降低,变化趋势有统计学意义(P<0.001)。结论:2016年至2019年国内约42.7%胆道闭锁住院患儿放弃Kasai手术治疗,入院年龄为20~100 d的患儿选择Kasai手术的比例高于其他入院年龄段患儿,近年来选择Kasai手术的患儿比例逐渐提高。Objective To explore the current status of diagnosing and treating biliary atresia(BA)children in China and to grasp baseline profiles,preference of treatment and trend of Kasai operative ratio in recent years.Methods For this cross-sectional study,2471 BA children(ICD-10 code Q44.2)were discharged from 23 pediatric centers in China between January 1,2016 and December 31,2019.The relevant clinical data of gender,admission age and treatment were extracted from first page of inpatient medical record.Children with an admission age>180 days or re-admitted individuals were excluded.Choices of treatment were compared among different age groups and trend of Kasai operative ratio by year was analyzed.Results There were 1154(46.7%)boys and 1317(53.3%)girls with a median admission age of 55(43-72)days.Kasai operation(n=1417,57.3%),bile duct exploration alone(n=445,18.0%)and non-surgical interventions(n=609,24.7%)were performed.Kasai operative ratio was 60.8%in children with an admission age of(21-100)days.It was higher than those with an age of 0-20 days(37.9%)and≥101 days(27.9%)(P<0.001).The ratio of Kasai operation spiked yearly from 45.2%in 2016 to 72.3%in 2019.And this trend was statistically significant(P<0.001).Conclusions From 2016 to 2019,about 42.7%of BA children refused Kasai operation.The ratio of Kasai operation was higher in children with an admission age of(20-100)days than the others.And the ratio of Kasai operation is rising gradually in recent years.

关 键 词：胆道闭锁 肝门肠吻合术 治疗 趋势分析 

分 类 号：R725.7[医药卫生—儿科]