胆道闭锁Kasai手术疗效及术后黄疸清除的相关因素分析  

Analysis of the efficacy of Kasai surgery for biliary atresia and analysis of the related factors of postoperative jaundice clearance

作　　者：谢镇宇 蒲思宇 张一茂 王琦[1] 宋九林 陈阳[1] 向波[1] 靳曙光[1] Xie Zhenyu;Pu Siyu;Zhang Yimao;Wang Qi;Song jiulin;Chen Yang;Xiang Bo;Jin Shuguang(Department of Pediatric Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院小儿外科,成都610041

出　　处：《临床小儿外科杂志》2025年第2期152-158,共7页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(81571473)。

摘　　要：目的总结胆道闭锁Kasai手术治疗效果,探讨影响Kasai手术后黄疸清除的相关因素。方法回顾性分析四川大学华西医院小儿外科自2015年9月至2022年8月期间收治的340例胆道闭锁患儿临床资料,男160例、女180例,日龄(47.47±11.61)d,其中接受Kasai手术227例(开放手术124例、腹腔镜手术103例)。收集所有接受Kasai手术患儿的人口学资料、手术情况、临床指标、病理资料,分析影响胆道闭锁Kasai手术后黄疸清除的因素。结果本研究中Kasai手术后患儿黄疸最终消退率为65.20%(146/227),Kasai手术后5年自体肝累计生存率为35.20%。年龄(P=0.025)、彩超下肝门部纤维包块厚度(P=0.016)、肝门部纤维包块横截面单位面积小胆管直径≥150μm数目(P=0.012)、术后6个月内胆管炎发作频次(P=0.035)以及肝弹性值(P=0.029)对Kasai手术后黄疸消退率具有明显影响。对P<0.05的影响因素进行多因素Logistic回归分析显示,年龄、彩超下肝门部纤维包块厚度、肝门部纤维包块横截面单位面积小胆管直径≥150μm数目、术后6个月内胆管炎发作频次是Kasai手术后黄疸消退的独立影响因素。结论胆道闭锁Kasai手术后退黄效果总体较好,可有效延长患儿自体肝生存率。年龄、彩超下肝门部纤维包块厚度、肝门部纤维包块横截面单位面积小胆管直径≥150μm数目以及术后6个月内胆管炎发作频次会影响手术后退黄效果。Objective To summarize the effect of Kasai procedure of biliary atresia(BA)and explore the relevant factors affecting the clearance of postoperative jaundice.Methods The relevant clinical data were retrospectively reviewed for 340 BA children admitted from September 2015 to August 2022.There were 160 boys and 180 girls with an average age of(47.47±11.61)day.The procedures were Kasai(n=227),open surgery(n=124)and laparoscopy(n=103).Demographic profiles,surgical findings,clinical parameters and pathological examinations were recorded for examining the factors affecting the clearance of jaundice after Kasai surgery for BA.Results The final clearance of jaundice in our group of children was 65.20%(146/227)and the cumulative survival rate of native liver at 5 years after Kasai procedure 35.20%.Age(P=0.025),ultrasonic thickness of hepatic hilar fibrous tissue(P=0.016),frequency of cholangitis episodes within 6-month postoperative period(P=0.035)and hepatic elasticity value(P=0.029)had a significant impact on jaundice clearance rate after Kasai’s procedure.Multifactorial Logistic regression analysis of the influencing factors at P<0.05 showed that age,ultrasonic thickness of fibrous tissue in hepatic portal,number of small bile ducts≥150μm in diameter per unit cross-sectional area of fibrous tissue in hepatic hilar region and frequency of cholangitis episodes within 6-month postoperative period were the independent risk factors for the clearance of postoperative jaundice after Kasai procedure.Conclusions The overall outcome of jaundice clearance after Kasai procedure for BA is efficacious and it may prolong native liver survival.

关 键 词：胆道闭锁 外科手术 Kasai手术 治疗效果 术后并发症 

分 类 号：R726.5[医药卫生—儿科]