CAJ | 학술논문

目的评价Kasai手术(肝门肠吻合术)对活体肝移植治疗儿童胆道闭锁的影响.方法对2010年3月至2013年3月实施的53例小儿活体肝移植进行回顾性分析,其中28例(52.8％)受者先行Kasai手术后接受活体肝移植,25例(47.2％)受者直接接受活体肝移植,将其分别分为Ka-sai组和非Kasai组.比较两组受者的一般资料、术后并发症和累积生存率的差异.结果两组受者移植时的年龄、体质量、术前胆红素水平、PELD评分及手术时间比较,差异有统计学意义(均P＜0.05),移植物质量、GRWR、热缺血时间、冷缺血时间、失血量、输血量、ICU停留时间及住院时间比较,差异无统计学意义(均P＞0.05).两组受者的肺部感染、腹腔感染、伤口感染、败血症、急性排斥反应、门静脉吻合口狭窄、CMV/EB病毒感染及胆道并发症等并发症发生率比较,差异无统计学意义(均P＞0.05).53例受者中有4例死亡,Kasai组死亡3例,非Kasai组死亡1例,死亡主要原因为移植物功能衰竭,供者均无严重并发症及死亡.全部受者术后1个月、1年和3年累积生存率分别为94.3％、92.5％、92.5％.Kasai组术后1个月、1年和3年累积生存率分别为92.9％、89.3％、89.3％,非Kasai组术后1个月、1年和3年累积生存率分别为96％、96％、96％,两组比较差异无统计学意义(P=0.4069).结论 Kasai手术作为胆道闭锁序贯治疗的第一步,并没有增加移植术后并发症的发生率及死亡率.相较而言,成功的Kasai手术可以推迟移植的时间,移植实施的越晚,术后并发症的发生率及病死率反而较低.
목적 평개Kasai수술(간문장문합술)대활체간이식치료인동담도폐쇄적영향.방법 대2010년3월지2013년3월실시적53례소인활체간이식진행회고성분석,기중28례(52.8％)수자선행Kasai수술후접수활체간이식,25례(47.2％)수자직접접수활체간이식,장기분별분위Ka-sai조화비Kasai조.비교량조수자적일반자료、술후병발증화루적생존솔적차이.결과 량조수자이식시적년령、체질량、술전담홍소수평、PELD평분급수술시간비교,차이유통계학의의(균P＜0.05),이식물질량、GRWR、열결혈시간、랭결혈시간、실혈량、수혈량、ICU정류시간급주원시간비교,차이무통계학의의(균P＞0.05).량조수자적폐부감염、복강감염、상구감염、패혈증、급성배척반응、문정맥문합구협착、CMV/EB병독감염급담도병발증등병발증발생솔비교,차이무통계학의의(균P＞0.05).53례수자중유4례사망,Kasai조사망3례,비Kasai조사망1례,사망주요원인위이식물공능쇠갈,공자균무엄중병발증급사망.전부수자술후1개월、1년화3년루적생존솔분별위94.3％、92.5％、92.5％.Kasai조술후1개월、1년화3년루적생존솔분별위92.9％、89.3％、89.3％,비Kasai조술후1개월、1년화3년루적생존솔분별위96％、96％、96％,량조비교차이무통계학의의(P=0.4069).결론 Kasai수술작위담도폐쇄서관치료적제일보,병몰유증가이식술후병발증적발생솔급사망솔.상교이언,성공적Kasai수술가이추지이식적시간,이식실시적월만,술후병발증적발생솔급병사솔반이교저.
Objective To evaluate the effects of Kasai operation on living donor liver transplantation (LDLT) for children with biliary atresia.Methods Retrospective reviews were conducted for 53 children undergoing LDLT from March 2010 to March 2013.Among them,28(52.8％) underwent LDLT after Kasai operation while 19(35.8％) had LDLT without prior Kasai operation.The intergroup differences of general profiles,postoperative complications and cumulative survival rate were compared.Results Significant differences existed in age and weight at transplantation,pretransplant bilirubin level,pediatric end-stage liver disease (PELD) score and operative duration (all P＜0.05) while there were no significant inter-group differences in graft/recipient weight ratio (GRWR),graft weight,warm ischemia time,cold ischemia time,blood loss,blood transfusion and hospital stay (all P＞0.05).No significant inter-group differences existed in the incidence of such complications as pulmonary infection,abdominal cavity infection,wound infection,sepsis,acute rejection,portal venous anastomotic stenosis,cytomegalovirus/Epstein-Barr virus infection or biliary complications (all P＞0.05).Among 4 deceased recipients,3 died from graft failure in Kasai group and another in non-Kasai group.No donor mortality was encountered.The overall 1-month,1 and 3-year cumulative survival rates for recipients were 98.1％,92.5 ％ and 92.5 ％ and the 1-month,1 and 3-year cumulative survival rates for Kasai group were 92.9％,89.3％ and 89.3％ respectively.And the 1-month,1 and 3-year cumulative survival rates for non-Kasai group were 96％,96％ and 96％ respectively.No significant inter-group differences existed (P =0.4069).Conclusions As the first sequential treatment for biliaryatresia,Kasai operation does not increase the incidence of complications and mortality after transplantation.And its success may postpone transplantation.The later in life transplantation must be performed,the lower the incidence of complications and mortality is noted.