胆道闭锁Kasai术后相关预后因素分析和对策

发布时间：2019-03-12 12:39

【摘要】：目的:1955年由日本人Kasai首创了肝门空肠吻合术,Kasai的第一例手术患者中最长存活时间为33岁,近30年随着中内外肝移植应用于胆道闭锁患儿,使得患儿可以长期生存,但目前尚无一人超过Kasai的记录,远期效果仍不清楚,Kasai术仍然为治疗胆道闭锁患儿的首选治疗方法。本文将探究胆道闭锁(biliary atresia,BA)Kasai术后的相关预后因素,了解我省该疾病的治疗现状,探索影响该病预后的因素。方法:回顾性分析2009年1月至2015年12月期间,在山西省儿童医院新生外科行腹腔镜探查、胆道造影确诊为胆道闭锁后行Kasai术并随访资料完整的91例患儿。采用Kaplan-Meier法计算各亚组患者自体肝存活率。各亚组之间患者自体肝存活率的比较应用Log-rank方法检验,多因素分析将采用COX回归模型。结果:全组患者6个月、1年、2年的自体肝存活率分别为76.92%(70/91)、48.35%(44/91)、36.26%(33/91)。手术日龄:患者手术日龄d60、60≤d90、90≤d120、d≥120组2年累计自体肝存活率分别为58.8%、46.3%、11.1%、0(p=0.047);男性和女性的2年累计自体肝存活率分别为36.4%和46.8%,(p=0.313);有胆管炎发作组与无胆管炎发作组的2年累计自体肝存活率分别为32.8%和62.5%(p=0.011);黄疸消退明显组和黄疸消退不明显组的2年累计自体肝存活率分别为50.8%和23.3%(p=0.012);肝功恢复良好组和肝功恢复较差组的2年累计自体肝存活率分别为56.6%和21.1%(p=0.01);Ⅰ型、Ⅱ型、Ⅲ型闭锁的2年累计自体肝存活率分别为77.8%、66.7%、31.6%(p=0.023)。结论:手术日龄、有无胆管炎发作、黄疸消退情况、肝功恢复情况及胆道闭锁分型均为影响Kasai手术预后的相关影响因素。其中,手术日龄、黄疸消退情况和肝功恢复情况三者是影响Kasai术后生存率的独立影响因素。提高民众对胆道闭锁的认知水平,加强术后随访评估,对提高胆道闭锁生存率有重要意义。
[Abstract]:Objective: hepatojejunostomy was initiated by Japanese Kasai in 1955. The longest survival time of the first patient with Kasai was 33 years old. In the last 30 years, with the use of internal and external liver transplantation in children with biliary atresia, the patient could survive for a long time. However, no one has exceeded the record of Kasai, the long-term effect is still unclear, Kasai operation is still the first choice for the treatment of biliary atresia in children. In this paper, we will explore the prognostic factors of biliary atresia (biliary atresia,BA) after Kasai, understand the treatment status of the disease in our province, and explore the factors affecting the prognosis of the disease. Methods: from January 2009 to December 2015, 91 children with biliary atresia diagnosed as biliary atresia underwent laparoscopic exploration and cholangiography after laparoscopic exploration were performed in the Department of Neonatal surgery of Shanxi Children's Hospital. The follow-up data of 91 cases were followed up. Kaplan-Meier method was used to calculate the survival rate of autogenous liver in each subgroup. Log-rank method was used to test the survival rate of autogenous liver among the subgroups. COX regression model was used for multivariate analysis. Results: the survival rates of the patients at 6 months, 1 year and 2 years were 76.92% (70 / 91), 48.35% (44 / 91), 36.26% (33 / 91), respectively. The age of operation was 60, 60 鈮，

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