【摘要】：目的:1955年由日本人Kasai首創(chuàng)了肝門空腸吻合術,Kasai的第一例手術患者中最長存活時間為33歲,近30年隨著中內外肝移植應用于膽道閉鎖患兒,使得患兒可以長期生存,但目前尚無一人超過Kasai的記錄,遠期效果仍不清楚,Kasai術仍然為治療膽道閉鎖患兒的首選治療方法。本文將探究膽道閉鎖(biliary atresia,BA)Kasai術后的相關預后因素,了解我省該疾病的治療現(xiàn)狀,探索影響該病預后的因素。方法:回顧性分析2009年1月至2015年12月期間,在山西省兒童醫(yī)院新生外科行腹腔鏡探查、膽道造影確診為膽道閉鎖后行Kasai術并隨訪資料完整的91例患兒。采用Kaplan-Meier法計算各亞組患者自體肝存活率。各亞組之間患者自體肝存活率的比較應用Log-rank方法檢驗,多因素分析將采用COX回歸模型。結果:全組患者6個月、1年、2年的自體肝存活率分別為76.92%(70/91)、48.35%(44/91)、36.26%(33/91)。手術日齡:患者手術日齡d60、60≤d90、90≤d120、d≥120組2年累計自體肝存活率分別為58.8%、46.3%、11.1%、0(p=0.047);男性和女性的2年累計自體肝存活率分別為36.4%和46.8%,(p=0.313);有膽管炎發(fā)作組與無膽管炎發(fā)作組的2年累計自體肝存活率分別為32.8%和62.5%(p=0.011);黃疸消退明顯組和黃疸消退不明顯組的2年累計自體肝存活率分別為50.8%和23.3%(p=0.012);肝功恢復良好組和肝功恢復較差組的2年累計自體肝存活率分別為56.6%和21.1%(p=0.01);Ⅰ型、Ⅱ型、Ⅲ型閉鎖的2年累計自體肝存活率分別為77.8%、66.7%、31.6%(p=0.023)。結論:手術日齡、有無膽管炎發(fā)作、黃疸消退情況、肝功恢復情況及膽道閉鎖分型均為影響Kasai手術預后的相關影響因素。其中,手術日齡、黃疸消退情況和肝功恢復情況三者是影響Kasai術后生存率的獨立影響因素。提高民眾對膽道閉鎖的認知水平,加強術后隨訪評估,對提高膽道閉鎖生存率有重要意義。
[Abstract]:Objective: hepatojejunostomy was initiated by Japanese Kasai in 1955. The longest survival time of the first patient with Kasai was 33 years old. In the last 30 years, with the use of internal and external liver transplantation in children with biliary atresia, the patient could survive for a long time. However, no one has exceeded the record of Kasai, the long-term effect is still unclear, Kasai operation is still the first choice for the treatment of biliary atresia in children. In this paper, we will explore the prognostic factors of biliary atresia (biliary atresia,BA) after Kasai, understand the treatment status of the disease in our province, and explore the factors affecting the prognosis of the disease. Methods: from January 2009 to December 2015, 91 children with biliary atresia diagnosed as biliary atresia underwent laparoscopic exploration and cholangiography after laparoscopic exploration were performed in the Department of Neonatal surgery of Shanxi Children's Hospital. The follow-up data of 91 cases were followed up. Kaplan-Meier method was used to calculate the survival rate of autogenous liver in each subgroup. Log-rank method was used to test the survival rate of autogenous liver among the subgroups. COX regression model was used for multivariate analysis. Results: the survival rates of the patients at 6 months, 1 year and 2 years were 76.92% (70 / 91), 48.35% (44 / 91), 36.26% (33 / 91), respectively. The age of operation was 60, 60 鈮，

本文編號：2438783