胆道闭锁患儿kasai术后疗效及影响因素分析

Analysis of Therapeutic Efficacy and Influencing Factors After Kasai Surgery in Infants with Biliary Atresia

目的分析胆道闭锁(biliary astresia,BA)患儿肝门-空肠吻合术(kasai)后疗效及影响因素。方法回顾性分析2013年5月至2015年11月于四川大学华西医院行kasai术并随访到完整资料的75例BA患儿,分析其诊疗过程与术后6个月、1年、2年累积自体肝生存率,依据手术日龄、BA分型及术后黄疸消退、肝功能恢复、胆管炎发生情况将其分为不同亚组,对比其累积自体肝生存率,并采用多因素Cox回归模型分析BA患儿术后疗效影响因素。结果 75例BA患儿术后6个月、1年、2年累积自体肝生存率分别为84.00%(63/75)、77.33%(58/75)、61.33%(46/75);不同手术日龄、BA分型患儿2年累积自体肝生存率对比差异有统计学意义(P<0.05),黄疸消退不明显、肝功能恢复较差、发生胆管炎患儿术后2年累积自体肝生存率(50.00%、45.45%、50.91%)低于黄疸消退明显、肝功能恢复良好、未发生胆管炎患儿术后2年累积自体肝生存率(77.42%、83.87%、90.00%)(P<0.05);多因素COX回归模型分析显示,手术日龄长、黄疸消退不明显、肝功能恢复较差、发生胆管炎是BA患儿kasai术后疗效的独立影响因素(P<0.05)。结论 kasai术是目前治疗BA首选方案,但手术日龄、黄疸消退不明显、肝功能恢复较差、发生胆管炎仍是患儿术后疗效的影响因素,应加强术后随访评估。

Objective To analyze the postoperative efficacy and influential factors after hepatic-jejunal anastomosis(Kasai)in infants with biliary atresia(BA).Methods The complete data of 75 BA infants treated with Kasai surgery from May of 2013 to November of 2015 in West China Hospital of Sichuan University were collected and analyzed retrospectively.The cumulative autologous liver survival rates were analyzed during the process of diagnosis and treatment and 6 months,1 year and 2 years after operation.The cases were divided into the different subgroups according to the operation days,BA types and postoperative jaundice elimination,liver function recovery and the occurrence of cholangitis.The cumulative autologous liver survival rates were compared,and the multivariate COX regression model analysis was used to analyze the influencing factors for postoperative efficacy of BA infants.Results The cumulative autologous liver survival rates were 84.00%(63/75),77.33%(58/75)and 61.33%(46/75)among the 75 cases of BA infants 6 months,1 year and 2 years after operation respectively.There were statistically significant differences in the 2-year cumulative autologous liver survival rates among the patients with different operation days and BA types respectively(P<0.05).The postoperative 2-year cumulative autologous liver survival rates in the infants with the unapparent jaundice elimination,poor liver function recovery and cholangitis occurrence were 50.00%,45.45%and 50.91%respectively,and they were significantly lower than those in infants with the apparent jaundice elimination,good liver function recovery and no cholangitis occurrence,which were 77.42%,83.87%and 90.00%respectively(P<0.05).The multivariate COX regression model analysis showed that the more operation days,unapparent jaundice elimination,poor liver function recovery and cholangitis occurrence were the independent influencing factors for the postoperative efficacy after Kasai surgery in BA infants(P<0.05).Conclusion The Kasai surgery is currently the preferred regimen in treatment of BA,but the operation days,unapparent jaundice elimination,poor liver function recovery and cholangitis occurrence are still the influencing factors for the postoperative efficacy of infants and the postoperative follow-up evaluation should be strengthened.