kassi术联合激素治疗婴幼儿胆道闭锁的疗效观察

Observation on efficacy of kassi surgery combined with hormone therapy on biliary atresia in infants

目的探讨改良kassi术联合激素治疗婴幼儿胆道闭锁(BA)的疗效。方法82例BA患儿均接受改良kassi术治疗,按照不同治疗方式分为2组,其中选择大剂量甲基泼尼松龙冲击治疗的50例病例为观察组,另选择小剂量甲基泼尼松龙维持治疗的32例病例为对照组,对比两组患儿的术前及治疗后的血清胆红素水平、术后6个月的黄疸消退情况、激素相关并发症情况及术后6个月的胆管炎发生情况,分析两组患儿进行6~36个随访期间的自体肝生存率。结果治疗后,两组的血清总胆红素、直接胆红素水平较术前显著降低,观察组显著低于对照组(P<0.05);观察组黄疸消退率可达58.00%,显著高于对照组的31.25%(P<0.05);观察组激素相关并发症总发生率为10.00%,对照组为3.13%,两组间对比差异无统计学意义(P>0.05);观察组术后胆管炎发生率为24.00%,显著低于对照组的53.13%(P<0.05);所有患儿进行为期6~36个月随访观察,患儿自体肝总生存率为70.73%,观察组术后自体肝1年生存率为86.00%,2年生存率为70.00%,对照组术后自体肝1年生存率为87.50%,2年生存率为71.88%,两组患儿生存率经Log-rank检验得出,差异无统计学意义(P>0.05)。结论改良kassi术联合激素治疗BA疗效确切,相比小剂量甲基泼尼松龙维持治疗,大剂量甲基泼尼松龙冲击治疗在改善血清胆红素水平和降低术后术后胆管炎方面优势显著,且并未增加激素相关并发症,但并不能延长患儿自体肝生存年限。

Objective To investigate the efficacy of modified kassi surgery combined with hormone therapy on biliary atresia(BA)in infants.Methods Eighty-two BA children patients were treated with modified kassi surgery,and they were divided into two groups according to different treatment methods.Among them,50 cases with high-dose methylprednisolone shock therapy were selected as observation group,and 32 cases with low-dose methylprednisolone maintenance therapy were selected as control group.The serum bilirubin level before surgery and after treatment,jaundice resolution and hormone-related complications at 6 months after surgery and occurrence of cholangitis at 6 months after surgery were compared between the two groups.The autologous liver survival rate was analyzed in the two groups during 6 to 36 months of follow-up.Results After treatment,the levels of serum total bilirubin and direct bilirubin in the two groups were significantly decreased compared with those before surgery,and the levels in observation group were significantly lower than those in control group(P<0.05).The jaundice resolution rate in observation group was significantly higher than that in control group(58.00%vs 31.25%)(P<0.05).The total incidence rate of hormone-related complications was 10.00%in observation group and was 3.13%in control group(P>0.05).The incidence rate of postoperative cholangitis in observation group was significantly lower than that in control group(24.00%vs 53.13%)(P<0.05).All children patients were followed up for 6 to 36 months,and the overall survival rate of autologous liver of patients was 70.73%,and the 1-year survival rate and the 2-year survival rate of autologous liver after surgery were 86.00%and 70.00%in observation group and were 87.50%and 71.88%in control group.Log-rank test concluded that there was no statistically significant difference in the survival rate between the two groups(P>0.05).Conclusion Modified kassi surgery combined with hormone therapy has exact efficacy in treating BA.Compared with low-dose methylprednisolone maintenance therapy,high-dose methylprednisolone shock therapy has significant advantages in improving serum bilirubin level and reducing postoperative cholangitis,and it dose not increase hormone-related complications,but it can not prolong the survival time of autologous liver in children patients.