摘要
目的分析胆道闭锁（BA）儿童肝脏移植的临床疗效及预后。方法对2006年9月至2013年10月期间的130例BA患儿资料进行回顾性分析。分析肝移植术前有无Kasai手术史、移植手术方式、术前及术中参数与预后的关系以及各种并发症的发生情况。结果130例患儿中术前已行Kasai手术的患儿80例，中位年龄为12．8个月（5．9～136．4个月），术前行腹部探查的患儿23例，中位年龄为7．4个月（5．8～43．0个月），无腹部手术史的患儿27例，中位年龄9．0个月（6．0～18．0个月），已行Kasai手术的患儿比其他患儿接受移植时的年龄明显延长，差异有统计学意义（P〈0．01）。130例小儿肝移植中，活体肝移植94例，劈离式肝移植19例，DCD全肝移植17例；共有11例患儿死亡；受者中位年龄10．0个月（5．8～136．4个月）；中位体重8．0kg（4．5～37．0kg）；中位随访时间为10．1个月（3．6～149．3个月）；全部患儿1年、2年和3年受者累计生存率分别为92．1．O％、90．0％和90．0％，活体肝移植受者1年、2年和3年受者累计生存率分别为94．4％、94．4％和94．4％，劈离式肝移植受者1年、2年和3年受者累计生存率分别为84．2％、77．2oA和77．2oA；单因素Kaplan-Meier分析结果显示性别、移植物类型、供肝受体质量比（GRWR）、冷缺血时间、术后再次气管插以及受体是否有术后早期并发症因素与术后生存率相关；多因素Cox结果表明GRWR、术后再次气管插管、受体是否有术后早期并发症因素是预后的影响因素。结论肝脏移植做为治疗胆道闭锁等儿童终末期肝病的有效手段已经取得较好的疗效，活体肝移植与尸体供肝肝移植相比，受者可获得更为满意的长期生存。
Objective To analyze the clinical efficacy and prognosis of liver transplantation （LT） in children with biliary atresia （BA）. Methods Retrospective analyses were performed for 130 BA patients undergoing LT from September 2006 to October 2013. The relationship between history of Kasai operation, surgical procedures, pre- ＆ intra-operative parameters, prognosis and occurrence of various complications was analyzed. Results Among them,80 cases had a history of Kasai operation. Their median age was 12. 8 （5. 9-136. 4） months. And 23 cases had a history of abdominal exploration and a median age of 7. 4 （5. 8-43. 0） months. For 27 cases without a history of abdominal surgery, their median age was 9. 0（6. 0-18. 0） months. The age at transplantation was significantly longer in children with a history of Kasai operation than other children （P〈0. 01）. The transplantation procedures included living donor liver （n = 94）, split liver （n = 19） and 17 donation after cardiac death （DCD） whole liver （n = 17）. Eleven patients died during follow-up. The median recipient age was 10. 0 （5. 8- 136. 4） months,median weight 8.0（4. 5-37. 0） kg and median follow-up time 10. 1（0. 2-87. 4） months. The overall 1,2 ＆ 3-year cumulative survival rates were 92. 1%,90. 0% and 90. 0%; 1,2 ＆. 3-year cumulative survival rates of lying donor liver transplantation （LDLT） were 94. 4% ,94. 4% and 94. 4% and 1,2 ＆ 3-year cumulative survival rate of split liver transplantation （SPLT） were 84. 2 %, 77. 2 % and 77. 2% respectively. Univariate analysis showed that gender, type of graft, graft/recipienVs body weight ratio （GRWR）, cold ischemia time, postoperative re-intubation and early post-LT complications were associated with survival rate. Multivariable Cox results showed that GRWR, re-intubation and early post-LT complications were the influencing factors of prognosis. Conclusions As an effective treatment, liver transplantation in BA children has achieved satisfactory outcomes. Com
出处
《中华小儿外科杂志》
CSCD
北大核心
2014年第4期259-264,共6页
Chinese Journal of Pediatric Surgery
基金
天津市卫生局重点攻关课题（11KGl03）
关键词
胆道闭锁
肝移植
生存率
Biliary atresia
Liver transplantation
Survival rate
