摘要
目的探讨胆道闭锁Kasai术后的近中期疗效及其影响因素。方法回顾性分析2005年10月至2010年9月在本院行Kasai手术并获得随访的152例胆道闭锁患儿，男68例，女84例，手术时的中位日龄为75d（31～528d），平均（82．36±45．17）d，定期门诊复诊并电话随访，平均随访时间（20．11±16．611）个月（2-62个月），对其诊疗过程及随访情况进行分析，对黄疸消退情况、生存率及影响因素采用Kaplan-Meier生存分析、Coxregression分析及7。检验。结果Kasai术后黄疸消退率为50％（74／149），Ⅰ、Ⅱ、Ⅲ型患儿的黄疸消退率分别为67％、67％、47％，差异无统计学意义（P：0．306）；≤60d、60～≤90d、91～120d手术组患儿的黄疸消退率分别为54％、53％、46％，≥120d手术组患儿的黄疸消退率明显降低（25％），但差异无统计学意义（P=0．310）；胆管炎发生率57％（85／149），有无胆管炎发作的黄疸消退率分别为31％、75％，差异有统计学意义（P〈0.01）。Ka—plan-Meier生存分析Kasai术后2、4年的自体肝存活率分别为56％、49％，有胆管炎组和无胆管炎组的2年自体肝存活率分别为43％、77％，差异有统计学意义（P〈0．01）。结论Kasai手术是目前我国治疗胆道闭锁的首要方法，手术年龄和分型与Kasai术后的近中期效果无明显相关，胆管炎是影响Kasai术后效果的重要因素。
Objective To analyze the impact of age at Kasai operation on the short- and mid term outcome and the prognostic factors for biliary atresia (BA).Methods Records of 152 patientswith BA who were operated on in our unit between October 2005 and September 2010 were reviewed.Out of the 152 patients,68 were males and 84 were female,the mean age at Kasai operation was 82.3645.17 d with a range of 31 to 528 d,all the patients were regularly followed up except 3 perioperative death,the follow-up time ranged between 2 and 62 months (average,20.11 ± 16.11 m).The KaplanMeier,Cox regression and x2 test were used to analyze the clearance of jaundice,survival rate and prognostic factors.Results The total jaundice disappearance rate was 50％,no significant difference was found among type Ⅰ,Ⅱ and Ⅲ.The jaundice disappearance rates of patients underwent Kasai operation at age ≤60 d,60-≤90 d and 91-120 d were 54％,53％ and 46％,respectively.When the operative age was ≥120 d,the jaundice disappearance rates dropped to 25％,which was dramatically lower.The rate of cholangitis was 57％,and the cholangitis had a significant impact on the jaundice disappearance rates (P＜0.01).The 2,4-year postoperative native liver survival rates were 56％ and 49％,respectively.The 2-year native liver survival rate of patients with cholangitis was 43％,which was dramatically less than that of 77％ in patients without cholangitis.Conclusions Kasai operation is the primary therapy for children with BA,age at operation and type of BA are not related to the short-outcome of Kasai operation,cholangitis is a prognostic impact factor for biliary atresia.
出处
《中华小儿外科杂志》
CSCD
北大核心
2012年第1期16-20,共5页
Chinese Journal of Pediatric Surgery
基金
国家科技支撑计划项目（编号：2006BAI05A06）
北京市科技计划课题（编号：D101100050010064）
