220例Ⅲ型胆道闭锁Kasai手术预后的影响因素分析

The short- and mid-term prognosis and influencing factors of Kasai portoenterostomy for 220 cases of type m biliary atresia

目的探讨Ⅲ型胆道闭锁Kasai术后的中短期预后及其影响因素。方法回顾性分析2014年1月至2017年6月收治的220例行Kasai手术的DI型胆道闭锁患儿,其中男88例,女132例,患儿手术时的平均日龄(60±23)d,收集病历资料并进行电话随访,随访时间12-53个月。结果患儿Kasai术后1、2、3年的自体肝存活率分别为65%、59. 6%、57.0%。术后3个月的黄疸消退率为50. 5%;退黄组与未退黄组3年自体肝存活率分别为86. 8%和27.1%,差异有统计学意义(P<0. 05 )o胆管炎的整体发生率60%,有无胆管炎发作的黄疸消退率分别为55.3%和43. 2%,术后3年自体肝存活率分别为62. 4%和49.6%,差异无统计学意义。不同手术年龄组的患儿术后黄疸清除率及自体肝生存率的差异无统计学意义。结论Ⅲ型胆道闭锁患儿Kasai术后3年自体肝存活率可达57%,术后3个月黄疸消退情况是影响预后的主要因素,而手术年龄、有无胆管炎并不影响中短期自体肝生存率。

Objective To investigate the short- and mid?term prognosis and its influencing factors of Kasai portoenterostomy for type Ⅲ biliary atresia. Methods 220 infants with type ID biliary atresia who underwent Kasai surgery at Capital Pediatric Institution from Jan 2014 to June 2017 were retrospectively reviewed. There were 88 males and 132 females, with an average age at operation (60 ± 23 ) d. The follow up time ranged from 12 to 53 months. Results The survival rate with native liver ( SNL) at 1, 2, and 3 years after Kasai operation were 65%, 59. 6%, and 57. 0%, respectively. The clearance rate of jaundice within 3 months after Kasai was 50. 5%;3-year SNL of infants whose jaundice disappeared or did not after operation were 86. 8% and 27. 1%( P < 0. 05 ). The overall incidence of cholangitis was 60%. The clearance rate of jaundice in children with or without cholangitis was 55. 3% and 43. 2%, while the 3-year SNL were 62. 4% and 49. 6%, respectively (P > 0. 05 ). Conclusion The 3-year survival rate on their native liver after Kasai operation in infants with type Ⅲ biliary atresia can reach up to 57 %. The clearance of jaundice within 3 months post-operation is the main factor affecting prognosis. The age at surgery and the occurrence of cholangitis do not affect the survival rate of native liver in the short- and mid-term prognosis.