CAJ | 학술논문

目的研究胆道闭锁患儿Kasai手术术时年龄、肝脏病理与近期预后之间的相关性.方法对2008年7月至2011年6月收治于我院普外科的胆道闭锁患儿进行Kasai术后6个月的近期预后随访,分为优秀组、良好组和不良组.每组随机抽取20例共计60例作为样本.回顾样本病历资料获取术时年龄.获取样本病例Kasai手术术中取得并保存的肝脏病理标本,应用Masson染色评定肝纤维化程度;应用CK19免疫组化染色和图像分析技术评定胆管反应程度.统计学分析术时年龄、肝脏病理学指标和近期预后之间的相关性.结果优秀组、良好组和不良组的平均术时年龄分别为(77.55±24.64)d、(90.30±24.13)d和(72.35±24.53)d,无术时年龄＜30d病例;优秀组、良好组和不良组的无肝硬化病例和肝硬化病例分别为11:9、11:9和16:4;优秀组、良好组、不良组平均胆管面积比例分别为(5.62±3.62)％、(8.50±4.08)％和(5.15±3.77)％.不同预后病例术时年龄、肝脏病理学指标均无统计学差异;肝硬化组较无肝硬化组术时年龄无统计学差异,肝硬化组较无肝硬化组胆管反应程度严重;术时年龄与胆管反应呈显著线性正相关.结论胆道闭锁患儿Kasai术后6个月近期预后和术时年龄、肝纤维化程度、胆管反应程度均无明显相关性,近期预后可能受术者经验和手术技巧影响;术时年龄越大胆管反应越重,胆管反应对肝纤维化有促进作用,尽早手术对改善远期预后有帮助.
목적 연구담도폐쇄환인Kasai수술술시년령、간장병리여근기예후지간적상관성.방법 대2008년7월지2011년6월수치우아원보외과적담도폐쇄환인진행Kasai술후6개월적근기예후수방,분위우수조、량호조화불량조.매조수궤추취20례공계60례작위양본.회고양본병력자료획취술시년령.획취양본병례Kasai수술술중취득병보존적간장병리표본,응용Masson염색평정간섬유화정도;응용CK19면역조화염색화도상분석기술평정담관반응정도.통계학분석술시년령、간장병이학지표화근기예후지간적상관성.결과 우수조、량호조화불량조적평균술시년령분별위(77.55±24.64)d、(90.30±24.13)d화(72.35±24.53)d,무술시년령＜30d병례;우수조、량호조화불량조적무간경화병례화간경화병례분별위11:9、11:9화16:4;우수조、량호조、불량조평균담관면적비례분별위(5.62±3.62)％、(8.50±4.08)％화(5.15±3.77)％.불동예후병례술시년령、간장병이학지표균무통계학차이;간경화조교무간경화조술시년령무통계학차이,간경화조교무간경화조담관반응정도엄중;술시년령여담관반응정현저선성정상관.결론 담도폐쇄환인Kasai술후6개월근기예후화술시년령、간섬유화정도、담관반응정도균무명현상관성,근기예후가능수술자경험화수술기교영향;술시년령월대담관반응월중,담관반응대간섬유화유촉진작용,진조수술대개선원기예후유방조.
Objective To study the relevance of age at Kasai procedure,liver pathology and short-term prognosis in biliary atresia.Methods Biliary atresia patients admitted into our unit from June 2008 to June 2011 were chosen,and were followed up post-operatively for at least 6 months.The patients were divided into excellent,favorable and unfavorable groups.Sixty patients were randomly chosen as sample,with twenty patients from each group.Ages at Kasai procedure were noted in medical records.Liver biopsy samples achieved during Kasai procedure were well-preserved and available.Level of liver fibrosis was evaluated under microscope using Masson trichrome staining.Extent of ductular reaction was evaluated using CK19 immunohistochemistry staining with image analysis technology.The relevance of age at Kasai procedure,liver pathology indexes and short-term prognosis was analyzed statistically.Results Mean age at Kasai procedure of excellent,favorable and unfavorable groups were(77.55±24.64)d,(90.30±24.13)d and(72.35±24.53)d respectively,and no Kasai procedure was performed within 30 days.Ratios of non-cirrhosis to cirrhosis cases of excellent,favorable and unfavorable groups were 11:9,11:9 and 16:4 respectively.Mean percentages of ductular reaction area of excellent,favorable and unfavorable groups were(5.62±3.62)％,(8.50±4.08)％ and(5.15±3.77)％ respectively.There were no statistical differences of age at Kasai procedure and liver pathology indexes among excellent,favorable and unfavorable groups.There was no statistical difference of age at Kasai procedure between non-cirrhosis and cirrhosis groups,but ductular reaction of cirrhosis group was stronger than non-cirrhosis group.There was a significant positive linear correlation between age at Kasai procedure and extent of ductular reaction.Conclusions ①There was no significant relevance of 6-month short-term prognosis after Kasai procedure with age at operation,level of liver fibrosis,or extent of ductular reaction.Short-term prognosis might be affected by surgeons'experience and skill.②Extent of ductular reaction was positively related to age at Kasai procedure,and ductular reaction could promote liver fibrosis.So an early Kasai procedure might help improve long-term prognosis.