CAJ | 학술논문

目的评价肝门肠吻合术(Kasai手术)治疗胆道闭锁的效果并总结治疗经验.方法对2007年1月至2011年12月集中收治并采用统一的治疗方案进行Kasai手术的Ⅲ型胆道闭锁病例进行回顾性分析.结果进行Kasai手术的126例有112例(89.7％)获得完整随访.术后有70例黄疸清除,总黄疸清除率为62.5％,黄疸清除率在手术年龄≤60 d、60～90 d(包含90d)、90～120 d、＞120 d组分别为72.0％、80.5％、60.0％和19.0％,组间差异有统计学意义(P＜0.05).总胆管炎发生率为30.4％(34/112),黄疸清除组(15例)的胆管炎发生率(21.4％)低于未清除组(19例,45.2),组间差异有统计学意义(P＜0.05).术后68例(60.7％)出现持续肝纤维化,在各因素中分组中手术年龄＞90 d、黄疸未清除和胆管炎发作的病例,出现持续肝纤维化的比率较高(分别为93.5％,100％和50％),组间差异有统计学意义(P＜0.05).本组1年和2年自体肝生存率分别为64.9％和61.8％.单因素生存分析发现,患儿手术年龄、术后黄疸消退与否、胆管炎发作与否以及肝纤维化活动情况是影响自体肝生存的相关因素(P＜0.05).结论术后黄疸清除和胆管炎发作与否以及自体肝生存时间是胆道闭锁Kasai手术的评价指标,手术年龄≤90d,术后黄疸清除和较少的胆管炎发作有利于术后自体肝生存.
목적 평개간문장문합술(Kasai수술)치료담도폐쇄적효과병총결치료경험.방법 대2007년1월지2011년12월집중수치병채용통일적치료방안진행Kasai수술적Ⅲ형담도폐쇄병례진행회고성분석.결과 진행Kasai수술적126례유112례(89.7％)획득완정수방.술후유70례황달청제,총황달청제솔위62.5％,황달청제솔재수술년령≤60 d、60～90 d(포함90d)、90～120 d、＞120 d조분별위72.0％、80.5％、60.0％화19.0％,조간차이유통계학의의(P＜0.05).총담관염발생솔위30.4％(34/112),황달청제조(15례)적담관염발생솔(21.4％)저우미청제조(19례,45.2),조간차이유통계학의의(P＜0.05).술후68례(60.7％)출현지속간섬유화,재각인소중분조중수술년령＞90 d、황달미청제화담관염발작적병례,출현지속간섬유화적비솔교고(분별위93.5％,100％화50％),조간차이유통계학의의(P＜0.05).본조1년화2년자체간생존솔분별위64.9％화61.8％.단인소생존분석발현,환인수술년령、술후황달소퇴여부、담관염발작여부이급간섬유화활동정황시영향자체간생존적상관인소(P＜0.05).결론 술후황달청제화담관염발작여부이급자체간생존시간시담도폐쇄Kasai수술적평개지표,수술년령≤90d,술후황달청제화교소적담관염발작유리우술후자체간생존.
Objective To summarize our experience on Kasai procedure (KP) for the treatment of biliary atresia (BA).Methods From January 2007 to December 2011,126 patients with type ⅢBA underwent KP at this center.After surgery,112 (89.7％) of them was followed up,and their clinical data were retrospectively analyzed to evaluate the outcome.Results The jaundice free was seen in 70 (62.5％) patients.According to the age at surgery,the patients were divided into 4 groups:≤60 d group,60～90 d group,90～120 d group,and ＞120 d group.The jaundice free rates of the 4 groups were statistically different (jaundice free rate 72.0％,80.5％,60.0％,and 19.0％,respectively,P＜0.05).The incidence of cholangitis was 30.4％ (34/112).The incidence of cholangitis in jaundice free patients was significantly lower than that of the patients with persistent jaundice (21.4％versus 45.2％,P＜0.05).The patients with the age at surgery ＞90 d (93.5％),or persistent jaundice (100％),or postoperative cholangitis (50％),had a higher incidence of hepatic fibrosis.The 1-year and 2-year survival rate with native liver was 64.9％ and 61.8％ respectively.Age at surgery,jaundice,severity of cholangitis and persistent hepatic fibrosis,were the predictive factors for outcomes of surgery (P＜0.05).Conclusions The type Ⅲ BA patients who are younger than 90 days at surgery,jaundice free and less incidence cholangitis after surgery have longer survival time with native liver.