不同干预手段对先天性胆道闭锁葛西术后早期并发症的影响

Effects of Different Intervention Methods on Early Postoperative Complications in Patients with Congenital Biliary Atresia Undergoing Kasai

目的:探讨综合用药管理对先天性胆道闭锁(CBA)葛西手术(Kasai术)后早期并发症的影响。方法:回顾性分析2019年11月至2020年12月我院收治行Kasai术CBA患儿96例,按不同治疗方法分为对照组和观察组各48例。对照组于术后予以退黄、利胆、营养支持及激素冲击(短期)等基础治疗,观察组在对照组治疗基础上施行综合用药管理,主要为激素冲击(长期)及抗生素(预防性)使用,均持续治疗3个月。比较两组患儿治疗后黄疸清除率,统计术后早期并发症及激素相关并发症,随访至2022年3月,统计自体肝1年及2年生存率,并使用Kaplan-Meier法绘制生存曲线。结果:观察组黄疸清除率高于对照组(P<0.05);两组患儿激素相关并发症发生率比较差异无统计学意义(P>0.05);术后早期并发症中,观察组胆管炎发生率为41.67%,低于对照组的64.58%(P<0.05);随访截至2022年3月,随访时间4~31个月,中位随访时间25个月。经Log-Rank检验显示,两组患儿自体肝生存率比较差异无统计学意义(P>0.05)。结论:CBA患儿Kasai术后采用综合用药管理,可提高黄疸清除率,降低术后胆管炎发生率,激素相关并发症无明显增加,但并未延长自体肝1年及2年生存期。

Objective:To probe into the effects of comprehensive drug management on early postoperative complications in patients with congenital biliary atresia(CBA)undergoing Kasai surgery.Methods:Retrospective study was performed on 96 children with CBA undergoing Kasai surgery in our hospital from Nov.2019 to Dec.2020.All patients were divided into the control group and observation group according to different treatment methods,with 48 cases in each group.The control group was given basic treatment such as jaundice clearance and gallbladder function improvement,nutritional support and hormone shock therapy(short-term)after surgery,while the observation group received comprehensive drug management based on the treatment of the control group,mainly hormone shock therapy(long-term)and antibiotics(prophylaxis),all of which lasted for 3 months.The jaundice clearance rate after treatment,early postoperative complications and hormone-related complications of two groups were compared.Follow-up was performed until Mar.2022.The one-year and two-year survival rates of autologous liver were measured,and survival curves were plotted by using Kaplan-Meier method.Results:The jaundice clearance rate in the observation group was higher than that in the control group(P<0.05).There was no significant difference in the incidence of hormone-related complications between two groups(P>0.05).In the early postoperative complications,the incidence of cholangitis in the observation group was 41.67%,lower than 64.58%in the control group(P<0.05).The follow-up period was from 4 to 31 months and the median follow-up period was 25 months until Mar.2022.According to the Log-Rank test,there was no statistically significant difference in the survival rate of autologous liver between two groups(P>0.05).Conclusion:Comprehensive drug management after Kasai surgery in CBA children can improve the jaundice clearance rate,reduce the incidence of postoperative cholangitis,without increasing the incidence of hormone-related complications,which does not prolong the one-year and two-year survival of autologous liver.