胆道闭锁Kasai手术后未发生胆管炎患儿的近中期疗效及影响因素分析  

Analysis of short/medium-term effectiveness and influencing factors after Kasai surgery in patients with biliary atresia without cholangitis

作　　者：李斯锦 曾纪晓 徐晓钢 兰梦龙 陶波圆 梁子建 刘斐 Li Sijin;Zeng Jixiao;Xu Xiaogang;Lan Menglong;Tao Boyuan;Liang Zijian;Liu Fei(Department of Gastrointestinal Surgery,Municipal Women&Children’s Medical Center,Guangzhou Medical University,National Children’s Medical Center for South Central Region,Guangzhou 510120,China)

机构地区：[1]国家儿童区域医疗中心、广州医科大学附属妇女儿童医疗中心胃肠外科,广州510120

出　　处：《临床小儿外科杂志》2025年第1期30-34,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(82170528);广东省自然科学基金(2022A1515012254);广州市科技计划市校(院)联合资助项目(202201020612);广州地区临床特色技术项目(2023C-TS48);广州市科技计划市校(院)企联合资助项目(2024A03J1236)。

摘　　要：目的探讨胆道闭锁(biliary atresia, BA)Kasai手术后未发生胆管炎患儿的近中期疗效及其影响因素。方法回顾性分析2016年11月至2022年10月在广州医科大学附属妇女儿童医疗中心行Kasai手术治疗后未发生胆管炎的Ⅲ型BA患儿临床资料。根据早期胆汁引流情况分为早期胆汁引流良好组(early bile drainage-good, EBD-G组, n=25)和早期胆汁引流不良组(early bile drainage-poor, EBD-P组, n=45), 比较两组患儿一般资料、术前肝功能指标、肝纤维化程度及术后自体肝生存(native liver survival, NLS)率的差异。结果本研究共纳入符合纳排标准的患儿70例, 男31例、女39例, 术后6个月、1年、3年和5年NLS率分别为68.6%、51.4%、48.3%、48.3%。EBD-G组和EBD-P组术后6个月、1年、3年和5年NLS率分别为100%、95.8%、95.8%、95.8%和51.1%、26.7%、22.2%、22.2%;EBD-G组的NLS率较EBD-P组高, 差异有统计学意义(P<0.001)。EBD-P组手术日龄[(69.60±14.82)d比(61.84±14.96)d]、体重[(4.95±0.69)kg比(4.57±0.66)kg]和术前天门冬氨酸氨基转移酶(aspartate aminotransferase, AST)[(246.27±101.04)U/L比(178.20±64.45)U/L]水平大于或高于EBD-G组, 差异有统计学意义(P<0.05)。EBD-G组术前γ-谷氨酰转移酶(γ-glutamyl transferase, GGT)水平高于EBD-P组[654.00(391.00, 803.00)U/L比340.00(160.00, 460.00)U/L], 差异有统计学意义(P<0.05)。结论早期胆汁引流是Kasai手术后未发生胆管炎患儿NLS的重要影响因素, 手术日龄、体重、术前AST和GGT水平与术后早期胆汁引流相关。Objective To explore the short/medium-term efficacies and influencing factors after Kasai surgery in children with biliary atresia(BA)without cholangitis.Methods From November 2016 to October 2022,the clinical data were retrospectively reviewed for 70 typeⅢBA children without cholangitis after Kasai surgery.According to early bile drainage status,they were assigned into two groups of early bile drainage-good(EBD-G,n=25)and early bile drainage-poor(EBD-P,n=45).Two groups were compared with regards to general profiles,preoperative liver function parameters,degree of hepatic fibrosis and postoperative rate of native liver survival(NLS).Results There were 31 boys and 39 girls.NLS rates at Month 6 and Year 1/3/5 post-operation were 68.6%,51.4%,48.3% and 48.3%.NLS rates at Month 6 and Year 1/3/5 post-operation were 100%,95.8%,95.8%,95.8% and 51.1%,26.7%,22.2%,22.2% in EBD-G and EBD-P groups.NLS rate of EBD-G group was higher than that of EBD-P group with statistically significant differences(P<0.001).In EBD-P group,day age during Kasai surgery[(69.60±14.82)vs.(61.84±14.96)day],body weight [(4.95±0.69)vs.(4.57±0.66)kg]and preoperative aspartate aminotransferase(AST)[(246.27±101.04)vs.(178.20±64.45)U/L]were higher than those within EBD-G group and the difference was statistically significant(P<0.05).Preoperative level of γ-glutamyl transferase(GGT)was higher in EBD-G group than that in EBD-P group [654.00(391.09,803.00)vs.340.00(160.00,460.00)U/L]and there was statistically significant difference(P<0.05).Conclusions Early bile drainage is an important factor affecting NLS in children without cholangitis after Kasai surgery.Operative age,body weight and preoperative levels of AST and GGT are correlated with early bile drainage.

关 键 词：胆道闭锁 外科手术 手术后并发症 胆管炎 治疗结果 影响因素分析 

分 类 号：R65[医药卫生—外科学]