102例胆道闭锁Kasai术后胆管炎分析

Analysis of cholangitis in patients with biliary atresia after Kasai operation

目的分析102例胆道闭锁Kasai术后胆管炎的发生情况,探讨其与预后的关系,以加强对胆道闭锁Kasai术后胆管炎的诊治。方法对2009年1月至2016年6月山西省儿童医院行Kasai手术并统一术后治疗方案的102例胆道闭锁患儿进行随访,随访内容包括Kasai术后胆管炎发作的时间、次数及频率,术后是否遵嘱服药、治疗情况及疗效等,分析胆管炎与自体肝存活率、黄疸消退率及肝功能恢复等预后情况的关系。结果术后未发生胆管炎组及胆管炎发作组2年累计自体肝存活率分别为65.5%和41.1%(P=0.030)。早期胆管炎发作组和晚期胆管炎发作组其2年累计自体肝存活率分别为22.2%和52.2%(P=0.013)。早期胆管炎发作组和晚期胆管炎发作组的黄疸消退率分别为33.3%和67.4%(P=0.007)。早期胆管炎发作组和晚期胆管炎发作组的肝功恢复良好率为44.4%和73.9%(P=0.023)。频发胆管炎组与偶发胆管炎组的2年自体肝生存率分别为19.4%和57.1%(P=0.002),频发胆管炎组和偶发胆管炎组的黄疸消退率分别为38.7%和66.7%(P=0.001),频发胆管炎组和偶发胆管炎组的肝功能恢复良好率分别为45.2%和76.2%(P=0.008)。结论胆管炎尤其早期、频发胆管炎影响自体肝存活率、黄疸消退率及肝功能恢复,最终影响胆道闭锁预后。提高医患双方对胆道闭锁术后胆管炎的认识,加强对胆管炎的防治,对提高胆道闭锁生存率有重要意义。

Objective To explore the characteristics of eholangitis in patients with biliary atresia after Kasai operation and seek measures of improving the survival rate. Methods A retrospective review was con- ducted for 102 patients undergoing Kasai operation between January 2009 and June 2016. Results The 2-year survival rates of cholangitis attack or not were 41.1% and 65.5% （P =0. 030）. The 2-year survival rates of early episode of eholangitis group （EC） and late episode of cholangitis （LC） group were 22. 2% and 52. 2% （ P = 0. 013 ）. In EC and LC groups, jaundice subsiding rates were 33.3% and 67.4% （ P = 0. 007） and liver function recovery rates 44. 4% and 73.9% respectively （ P = 0. 023 ）. The 2-year survival rates of continual episode of cholangitis group （CC） and occasional episode of eholangitis （OC） group were 19.4% and 57. 1% （ P = 0. 002 ）. In CC and OC groups, jaundice subsiding rates were 38.7% and 66. 7% （ P = 0. 001 ） and liver function recovery rates 45.2% and 76. 2% respectively（ P = 0. 008 ）. Conclusions The stage and frequency of eholangitis have statistically significant differences in the outcomes after Kasai operation. It is vital for sur- geons to enhance the cognition and strengthen the prevention and treatment of cholangitis after Kasai operation. Then it is feasible to improve the survival rate of biliary atresia.