小儿胆道闭锁Kasai术后激素应用效果的临床分析

The Clinical Strategies of Hormone in the Treatment of Biliary Atresia after Kasai Procedure

为探讨胆道闭锁Kasai术后的皮质类激素应用的临床策略及患儿获益情况,分析81例胆道闭锁患儿临床资料,比较胆道闭锁Kasai术后激素应用的不同方案与早期胆管炎发生率、黄疸消退率、Fibroscan肝脏硬度测量值及自体肝生存率。结果示对照组、试验1组、试验2组的黄疸清除率分别为40.0%、56.7%、67.7%;术后早期胆管炎发生率分别为65.0%、53.3%、45.1%;自体肝2年生存率为45.0%、73.3%、71.0%。胆道闭锁Kasai术后适量的激素应用可提高黄疸清除率、降低早期胆管炎发生率、延长自体肝生存时间,过度增加剂量及疗程对提高远期生存率的作用不显著,且可能增加激素相关并发症。

To explore the clinical strategies of hormone in the treatment of biliary atresia after Kasai procedure and the benefit for children,we reviewed 81 patients with biliary atresia who underwent different hormone procedure,and compared the rates of jaundice clearance,occurrence of cholangitis,LSM,survival rates with the native liver,and the hormone-related complications.The patients were separated into three groups.There were statistical differences among control group,experimental group 1 and experimental group 2.The rates of jaundice clearance of control group,experimental group 1and experimental group 2were 40.0%,56.7%,and 67.7%;occurrence of early cholangitis were65.0%,53.3%,and 45.1%;and the 2y survival rates with the native liver were 45.0%,73.3%,and 71.0%.These data implied that appropriate hormone procedure may reduce the rates of cholangitis,and improve the rates of jaundice clearance,2y survival rates with the native liver;high-doses and long-periods hormone therapy may promote the hormonerelated complications.