Kasai术后肝内囊肿形成的危险因素分析及对预后的影响

Risk factors of intrahepatic cyst formation after Kasai portoenterostomy and its impact on prognosis

目的探讨Kasai术后肝内囊肿形成的危险因素、临床特点及其对预后的影响。方法回顾性分析2011年11月至2018年11月间天津市儿童医院外科Kasai手术后及准备行肝移植124例患儿的临床资料。包括Kasai手术年龄、术后的黄疸清除、胆管炎发作情况、术后肝功能、术后影像学检查、自体肝生存时间。其中符合正态分布的资料使用独立样本t检验进行分析,非正态分布的资料使用中位数、第25和第75百分位数表示,采用非参数的秩和检验(Mann-Whitney U)进行分析,计数资料行卡方检验,生存分析采用K-M生存分析。结果共收集124例患儿资料,其中男52例,女72例。Kasai手术日龄为11~158d(中位日龄:60.5d),自体肝生存时间为2.2~125.5个月(中位自体肝生存时间10.7个月)。术后形成肝内囊肿的患儿46例(37%)。Kasai术后女孩更易形成肝内囊肿(P<0.001),差异具有统计学意义。囊肿患儿的频发胆管炎、早期胆管炎的发生率高于无囊肿患儿(P<0.05),差异具有统计学意义。囊肿患儿相对于无囊肿患儿的自体肝生存率明显下降,但不同类型囊肿患儿在术后肝功能及自体肝生存时间上差异并无统计学意义。结论Kasai术后肝内囊肿形成与术后早期、频发胆管炎密切相关并且是预后不良的标志。

Objective To analyze the cases of intrahepatic cyst formation after Kasai portoenterostomy,and to explore the risk factors,clinical characteristics and prognosis of intrahepatic cyst formation after Kasai portoenterostomy.Methods The clinical data were retrospectively analyzed for of 124 children undergoing who underwent Kasai operation and awaiting for liver transplantation in the Department of Surgery,Tianjin Children's Hospital from November 2011 to November 2018.The relevant data included age at Kasai operation,jaundice clearance after surgery,cholangitis onset,postoperative liver function,postoperative imaging studies,and autologous liver survival time.The data conforming to normal distribution were analyzed by independent sample t test while those,with non-normal distribution were expressed by median,between 25th/and 75th percentile.The data were analyzed by non-parametric rank-sum test(Mann-Whitney U),the enumeration data were analyzed by chi-square test,and the survival analysis was performed by K-M methodsurvival analysis.Results A total of 124 children were collected,including 52 boys and 72 girls.Kasai operation was at 60.5(111-158)days,and the survival time of autologous liver was 10.7(2.2-125.5)months.Forty-six children(37%)developed postoperative cysts after surgery.Girls were more likely to form cysts after Kasai surgery(P<0.001),and the difference was statistically significant.The incidence of frequent cholangitis and early cholangitis in children with cysts was higher in children with cysts than those at in children without cysts(P<0.05),and the differences were statistically significant.The survival rate of autologous liver was significantly decreased significantly in children with cysts relative to those without cysts.However,but there was no significant difference existing in postoperative liver function and autologous liver survival time between children with different types of cysts.Conclusions Intrahepatic cyst formation after Kasai operation is closely correlated with early and frequent cholangitis.It is a sign of poor prognosis.