天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (7): 817-820.doi: 10.11958/20160239

• 专题研究·胆道闭锁与肝移植 • 上一篇    下一篇

Kasai手术对胆道闭锁儿童行活体肝移植术的影响

李姗霓*， 王凯*， 马楠， 孟醒初， 张威， 孙超， 董冲， 吴斌， 韩潮， 覃红， 高伟   

  1. 天津市第一中心医院小儿肝移植科， 东方器官移植中心（邮编 300192）
  • 收稿日期:2016-04-05 修回日期:2016-06-07 出版日期:2016-07-15 发布日期:2016-07-15
  • 通讯作者: 高伟 E-mail:gao-wei@medmail.com.cn
  • 作者简介:李姗霓（1977）， 女， 博士， 副主任医师， 主要从事儿童肝移植术后管理及随访工作； 王凯（1978）， 男， 博士， 副主任医师， 主要从事成人及儿童肝移植与移植免疫相关研究
  • 基金资助:
    国家自然科学基金资助项目

Effects of Kasai surgery on living donor liver transplantation in the treatment of children biliary atresia

LI Shanni*, WANG Kai*, MA Nan, MENG Xingchu, ZHANG Wei, SUN Chao, DONG Chong, WU Bin, HAN Chao, QIN Hong, GAO Wei△   

  1. Department of Pediatric Transplant of Tianjin First Center Hospital, Oriental Organ Transplant Center, Tianjin 300192, China
  • Received:2016-04-05 Revised:2016-06-07 Published:2016-07-15 Online:2016-07-15
  • Contact: Wei GAO E-mail:gao-wei@medmail.com.cn

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摘要： 目的 评价肝门-空肠吻合术（Kasai 手术）对胆道闭锁儿童行活体肝移植术治疗效果及预后的影响。 方法 对 2006 年 9 月—2014 年 9 月实施的 150 例活体肝移植患者资料进行回顾性分析， 其中 90 例受者先行 Kasai手术， 后接受活体肝移植（Kasai 组）； 60 例受者直接接受活体肝移植（非 Kasai 组）。 比较 2 组受者的一般资料、术后 并发症和累积生存率的差异。 结果 受者年龄为 4.9~87.0 个月 。 Kasai 组受者在移植时的移植月龄、体质量、身高 均高于非 Kasai 组， 而儿童终末期肝病（PELD）评分、术前胆红素水平则低于非 Kasai 组（均 P < 0.05）。 2 组移植物质量与受者体质量比（GRWR）、手术时间、术中失血量比较差异无统计学意义（均 P > 0.05）。 2 组受者的肺感染、急性排斥反应、门静脉吻合口狭窄、门脉血栓、肝动脉闭塞、胆漏、胆肠吻合口狭窄等发生率差异无统计学意义（均 P >0.05）。 Kasai 组肝移植术后总体并发症发生率为 61.1%， 高于非 Kasai 组的 43.3%（χ2=4.580， P=0.032）。 全部患者中 死亡 7 例（4.7%）， 其中 Kasai 组 6 例（4.0%）， 5 例为多器官功能衰竭， 1 例严重的肺感染； 非 Kasai 组 1 例（0.7%）， 因术前消化道出血急诊手术死于多器官功能衰竭。 供者均无严重并发症及死亡。 全部受者术后 1 个月 、1 年、3 年和 5年累积生存率分别为 98.6%、96.6%、94.9%， 92.7%。 其中， Kasai 组分别为 98.9%、96.5%、93.8%、91.3%； 非 Kasai 组分别为 98.3%、96.6%、96.4%、95.5%， 2 组比较差异无统计学意义（χ2=1.490， P=0.222）。 结论 胆道闭锁患者在 Kasai术后行活体肝移植术可获得满意的临床效果， 不会增加移植术后主要并发症的发生率及死亡比例， 长期生存率与未接受 Kasai 手术的患者相当。 且 Kasai 手术可推迟行肝移植的时间、利于儿童生长发育、减轻移植术前黄疸。

关键词: 胆道闭锁, 肝移植, Kasai 手术, 儿童

Abstract: Objective To evaluate the effects of portoenterostomy (Kasai surgery) on living donor liver transplantation (LDLT) for children with biliary atresia (BA). Methods A total of 150 children with BA, who were treated with LDLT in our center from September 2006 to September 2014, were retrospectively analysed. The children were categorized into Kasai group (90 cases, 60% ) and non- Kasai (60 cases, 40% ) group, based on whether they had previously undergone Kasai procedure pre-LDLT. Clinical data, incidence of complications and accumulated survival rates were compared between twogroups. Results The ages of pediatric patients were 4.9-87.0 months. The patient age and height were significantly higher in Kasai group than those of non-Kasai group (P < 0.05). The serum bilirubin level was lower before surgery in Kasai group than that of non-Kasai group (P < 0.05). There were no significant differences in body weight, pediatric end stage of liver disease (PELD) score, graft to recipient body weight ratio (GRWR), operation time and blood loss between two groups (P > 0.05). Similarly, there were no significant differences in pulmonary infection, acute rejection, portal vein thrombosis, hepatic artery occlusion and biliary complications between the two groups (P > 0.05). The overall complication rate of post-LDLT was 61.1% in Kasai group, which was higher than that in non-Kasai group (43.3%,χ2=4.580, P=0.032). Totally, there were 7 cases (4.7%) died on post-LDLT, in which there were 6 cases (4.0%) in Kasai group including 5 cases of multiple organfailure and 1 case of severe pulmonary infection, and 1 case (0.7%) in non-Kasai group, who died of multiple organ failure due to preoperative gastrointestinal bleeding for emergency surgery. There were no serious complications and death in donors. The overall cumulative survival rates were 98.6%, 96.6%, 94.9% and 92.7% in 1 month, 1 year, 3 years and 5 years after LDLT, respectively. And there were no significant differences in survival rates in 1 month, 1 year, 3 years and 5 years between two groups (χ2=1.490, P=0.222) with the rates of 98.9%, 96.5%, 93.8%, 91.3% in Kasai group and 98.3%, 96.6%, 96.4%, 95.5% in non-Kasai group. Conclusion Performing Kasai procedure can acquire satisfied results to pediatric patients with BA pre-LDLT, without increasing the incidence of major complications and mortality post-LDLT. And the accumulated survival rate is not different in pediatric patients received Kasai surgery compared with that in non-Kasai patient. Besides that, Kasai surgery might postpone the time of receiving LDLT, benefit to the growth of children and reduce the jaundice of pre-LDLT.

Key words: biliary atresia, liver transplantation, Kasai surgical, child