手术年龄对胆道闭锁Kasai手术后预后影响的研究

Operational age effect on the prognosis of Kasai procedure with biliary atresia.

目的探讨胆道闭锁患儿接受Kasai手术时的年龄对预后的影响。方法回顾性分析2001年1月～2005年2月我院85例行Kasai手术的胆道闭锁患儿病例资料。按手术年龄分为<60d组32例,60～90d组40例,>90d组13例。至2007年2月,获随访且术后存活时间超过2年的患儿27例。结果<60d组中,56.25%的患儿术后1个月血清胆红素较术前下降三分之一;40.63%的患儿术后3个月血清胆红素降至正常;46.88%的患儿术后6个月血清胆红素降至正常。60～90d组中,术后1个月血清胆红素下降三分之一、术后3个月及6个月降至正常率分别为65%、37.5%和50%。>90d组患儿中则分别为46.15%、23.08%和23.08%。术后1个月、3个月血清胆红素下降率3组差异无统计学意义;>90d组患儿术后6个月黄疸消退率较其他两组降低,P<0.05。获随访的27例存活2年以上患儿中,<60d组、60～90d组和>90d组分别为15例、9例和3例,各占60%、32.14%和30%,P<0.05。结论胆道闭锁患儿早期手术(出生后1～3个月)血清胆红素下降快,黄疸消退率及2年以上存活率均明显高于晚期手术者;2年无黄疸生存预示长期生存和生活质量提高。

Objective To discuss effects of operational ages on the prognosis of kasia procedure with biliary atresia. Method 85 cases of biliary atresia in our hospital in-patients during Jan. 2001 to Feb. 2005 were operated with kasai procedure, clinical data were evaluated retrospectively. These patients were divided into three groups according to different operational ages. Group A as younger than 60 days, group B as 60 to 90 days and Group C as older than 90 days until July 2006. Followed up showed that there were 27 cases survival term over 2 years. Result The jaundice disappearance rate of Im, 3m and 6m after operation, group A were 56.25% , 40.63% and 46.88% respectively. Group B were 65%, 37.5% and 50% respectively. Group C were 46.15%, 23.08% and 23.08% respectively. There was no significant difference among three groups in 1 m and 3m postoperation, but group C has the lower jaundice disappearance rate of 6m （p〈O.05）. Two years survival rates of three groups were 15/25 （60%）, 9/28 （32.14%） and 3/10 （30） respectively （p〈O.05）. Conclusion The jaundice disappearance rate and two year survival rates in younger operational age （1-3 months） is higher than that of older operational age. Two years survival children without jaundice could have a long terms good life quality.