胆道闭锁Kasai手术后自体肝生存时间小于2年的危险因素分析

Risk factors of native liver survival time under 2 years after Kasai operation for biliary atresia

目的探讨胆道闭锁(biliary atresia,BA)Kasai手术后自体肝生存(native liver survival,NLS)时间小于2年的危险因素。方法回顾性分析山西省儿童医院2009年1月至2017年6月行Kasai手术的BA患者临床资料及随访资料。根据术后NLS时间是否小于2年分为死亡组(n=78)和生存组(n=46)。将BA分型、性别、巨细胞病毒(cytomegalovirus,CMV)感染、手术年龄、术后使用抗生素方案、术后使用激素方案、是否合并早期胆管炎及术后黄疸是否消退作为自变量,采用Kaplan-Meier法绘制生存曲线并进行Log-rank检验,采用Cox比例风险模型(逐步前进法)筛选BA患者Kasai手术后NLS时间小于2年的危险因素。结果共纳入124例BA患者,其中生存组46例,死亡组78例,2年NLS率为37.1%。单因素分析结果显示合并早期胆管炎及术后黄疸消退是影响BA患者术后2年NLS率的因素(P<0.05)。Cox比例风险模型分析结果显示术后3个月内黄疸未消退为BA患者Kasai手术后NLS时间小于2年的独立危险因素,术后3个月内黄疸未消退组患者NLS时间小于2年的风险是黄疸消退患者的5.65(95%CI:2.45~13.04)倍。结论BA患者Kasai手术后3个月内黄疸未消退是NLS时间小于2年的危险因素。

Objective To explore the risk factors of native liver survival(NLS)time under 2 years after Kasai operation for biliary atresia(BA).Methods Clinical and follow-up data were retrospectively analyzed for all children undergoing Kasai operation for BA from January 2009 to June 2017.According to whether or not NLS time was under 2 years,they were divided into survival and death groups.BA classification,gender,cytomegalovirus(CMV)infection,age at Kasai,postoperative antibiotic and hormone regimens,postoperative early cholangitis and jaundice clearance were independent variables.Kaplan-Meier survival analysis was employed for plotting the survival curves of two groups and log-rank test performed for assessing the inter-group difference.Cox proportional hazard models were constructed for assessing the risk factors of native liver survival time under 2 years.Within 3 months,the risk of NLS time under 2 years for non-clearing group was 5.65 folds of that for clearing group(95%CI:2.45-13.04).Results There were 46 cases in survival group and 78 in death group.And 2-year NLS rate was 37.1%.Univariate analysis showed that statistically significant difference existed in survival curve between two variables associated with postoperative early cholangitis and jaundice clearance(P<0.05).COX proportional risk model analysis indicated that failure of jaundice clearance within 3 months after Kasai operation was an independent risk factor for NLS time<2 years.Conclusion Failure of jaundice clearance within 3 months is a risk factor for NLS time under 2 years after Kasai operation for biliary atresia.