CAJ | 학술논문

目的探讨胆道闭锁Kasai手术对肝移植的影响,并总结其临床意义.方法回顾性分析86例胆汁淤积性肝硬化而进行肝移植的胆道闭锁患儿临床资料,将其分为Kasai组和非Kasai组,比较两组患儿黄疸发现时间、Kasai手术年龄、术后黄疸消退情况、发生胆管炎频次、肝移植年龄和进行肝移植手术时间,以及肝移植术前评估时相关实验室检查结果.结果非Kasai组肝移植年龄为174～1 285 d(平均310.9 d),肝移植手术时间为6h至12 h15 min(平均9 h17 min);Kasai组肝移植年龄为173～3 100 d(平均549.5 d),肝移植手术时间为5 h15 min至14 h(平均8 h 40 min).两组患儿在肝移植年龄和肝移植手术时间方面差异有统计学意义(P＜0.05);不同Kasai年龄组肝移植手术时间差异显著,其中31～60 d年龄组黄疸清除率高,胆管炎发生次数少,1年内进行肝移植的患儿最少,肝移植年龄最晚.Kasai组AST、TBIL、DBIL及IBIL明显低于非Kasai组,差异有统计学意义(P＜0.05).两组患儿均进行TORCH相关病毒检测,Kasai组各病毒感染阳性率均低于非Kasai组,而静脉血中细菌感染率较高;两组患儿肝脏纤维化程度均较重,Kasai组肝内胆管增生较重,而非Kasai组胆管增生相对较轻,肝内淤胆较重.结论 Kasai手术可以改善胆道闭锁患儿临床症状,缓解肝脏进行性损伤,减少肝移植手术时间,降低肝移植手术风险,为肝移植手术成功实施起到了保护作用.
목적 탐토담도폐쇄Kasai수술대간이식적영향,병총결기림상의의.방법 회고성분석86례담즙어적성간경화이진행간이식적담도폐쇄환인림상자료,장기분위Kasai조화비Kasai조,비교량조환인황달발현시간、Kasai수술년령、술후황달소퇴정황、발생담관염빈차、간이식년령화진행간이식수술시간,이급간이식술전평고시상관실험실검사결과.결과 비Kasai조간이식년령위174～1 285 d(평균310.9 d),간이식수술시간위6h지12 h15 min(평균9 h17 min);Kasai조간이식년령위173～3 100 d(평균549.5 d),간이식수술시간위5 h15 min지14 h(평균8 h 40 min).량조환인재간이식년령화간이식수술시간방면차이유통계학의의(P＜0.05);불동Kasai년령조간이식수술시간차이현저,기중31～60 d년령조황달청제솔고,담관염발생차수소,1년내진행간이식적환인최소,간이식년령최만.Kasai조AST、TBIL、DBIL급IBIL명현저우비Kasai조,차이유통계학의의(P＜0.05).량조환인균진행TORCH상관병독검측,Kasai조각병독감염양성솔균저우비Kasai조,이정맥혈중세균감염솔교고;량조환인간장섬유화정도균교중,Kasai조간내담관증생교중,이비Kasai조담관증생상대교경,간내어담교중.결론 Kasai수술가이개선담도폐쇄환인림상증상,완해간장진행성손상,감소간이식수술시간,강저간이식수술풍험,위간이식수술성공실시기도료보호작용.
Objective To explore the effects of Kasai procedure on the for liver transplantation for biliary atresia.Methods Retrospective analysis was performed for the clinical data of 86 children with cholestatic cirrhosis who required liver transplantation for biliary atresia.They were divided into non-Kasai and Kasai groups.And two groups were compared with regards to onset time of jaundice,Kasai surgery age,postoperative jaundice fading,frequency of cholangitis,transplantation age,operative duration and relevant laboratory parameters.Results Non-Kasai group:the average age of liver transplantation was 310.9 days (174-1 285) and average transplantation time 9 h 17 min (6 h-12 h15 min); Kasai group:the average age of transplantation was 549.5(173-3 100) days and the average surgical duration 8 h 40 min (5 h 15 min-14 h).Significant inter-group differences existed in transplantation age and surgical duration (P＜0.05); for different Kasai age groups,transplantation operative duration was significantly different.Among the age group of 31-60 days,the clearance rate of jaundice was quite high,there were fewer bouts of cholangitis and the least number of transplantation within 1 year and the age of transplantation was the oldest.The values of aspartate transaminase (AST),total bilirubin (TBIL),direct bilirubin (DBIL) and indirect bilirubin (IBIL) in Kasai group were significantly lower than those in non-Kasai group.And the differences were significant (P＜0.05).For TORCH virus detection,the virus positive rates of Kasai group were lower than those of non-Kasai group.But there was a higher blood bacterial infection.Both groups had severe liver fibrosis,Kasai group had obvious bile duct hyperplasia while cholestasis was more severe in non-Kasai group.Conclusions Kasai surgery may improve the clinical symptoms of biliary atresia,alleviate liver damage,decrease liver transplantation surgical duration and reduce the risk of liver transplantation.Thus it plays protective roles in successful liver transplantation.