天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (4): 351-355.doi: 10.11958/20190343

• 专题研究·胆道闭锁与肝移植 • 上一篇    下一篇

胆道闭锁Kasai术后早期行肝移植手术的危险因素分析

葛亮 1，詹江华 2△，高伟 3，余晨 1，赵升桥 1，徐晓丹 1，窦然 1   

  1. 1天津医科大学研究生院（邮编 300070）；2天津市儿童医院普外科；3天津市第一中心医院移植科
  • 收稿日期:2019-02-11 修回日期:2019-04-04 出版日期:2019-04-15 发布日期:2019-05-27
  • 通讯作者: 詹江华 E-mail:zhanjianghuatj@163.com
  • 作者简介:葛亮(1986)，男，博士在读，主要从事小儿外科、胆道闭锁方面研究
  • 基金资助:
    胆道闭锁肝纤维化中TGF-β信号通路机制及体内抑制研究;胆道闭锁序贯性治疗方案建立及可行性研究

Risk factors of early liver transplantation after Kasai procedure for biliary atresia

GE Liang1, ZHAN Jiang-hua2△, GAO Wei3, YU Chen1, ZHAO Sheng-qiao1, XU Xiao-dan1, DOU Ran1   

  1. 1 Graduate School of Tianjin Medical University, Tianjin 300070, China; 2 Department of Pediatric Surgery, Tianjin Children’s Hospital; 3 Department of Transplantation, Tianjin First Central Hospital
  • Received:2019-02-11 Revised:2019-04-04 Published:2019-04-15 Online:2019-05-27
  • Contact: zhanjianghua E-mail:zhanjianghuatj@163.com

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摘要： 目的 探讨胆道闭锁（BA）Kasai术后自体肝生存时间的影响因素，从而得出早期行肝移植手术的危险因 素，为 BA治疗提供循证医学证据。方法 回顾性分析 167例胆道闭锁 Kasai术后因肝功能衰竭行肝移植手术的患儿 资料，根据 Kasai手术与肝移植手术的间隔时间将其分为 G1组（≤6个月）、G2组（＞6个月~2年）和 G3组（>2年），比较 3组患儿性别、Kasai手术年龄、Kasai术后黄疸消除、Kasai术后胆管炎发生及肝移植时肝功能指标情况，采用c2检验、 方差分析、Kruskal-Wallis H检验和多分类 Logistic回归分析查找自体肝生存时间的影响因素，即早期行肝移植手术 的影响因素。结果 3组间性别、Kasai手术年龄差异无统计学意义。3组间 Kasai术后黄疸消除率差异有统计学意 义（P＜0.01），G1组至 G3组逐渐升高；术后早期胆管炎发生率差异有统计学意义（P＜0.05），G3组低于 G1组；术后晚 期胆管炎发生率差异有统计学意义（P＜0.01），G2 组高于 G1 组；术后频发胆管炎发生率差异有统计学意义（P＜ 0.05），G3组低于 G2组。多分类 Logistic回归分析示黄疸未消除是胆道闭锁 Kasai术后自体肝生存的危险因素。结 论 胆道闭锁 Kasai术后黄疸未消除及早期胆管炎影响 Kasai术后自体肝生存时间，与早期行肝移植手术存在相关 性，其中黄疸未消除是早期行肝移植手术的危险因素。

关键词: 胆道闭锁, 肝移植, 危险因素, 肝门-空肠吻合术

Abstract: Objective To explore the influencing factors of the survival time of autologous liver after Kasai procedure for biliary atresia(BA), and to find out the risk factors of early liver transplantation, so as to provide data of evidence-based medicine for BA treatment. Methods Data of 167 BA children underwent liver transplantation due to hepatic failure after Kasai procedure were retrospectively analyzed. According to the operation interval between Kasai procedure and liver transplantation, they were divided into G1 (≤6 months), G2 (＞6 months - 2 years) and G3 (>2 years) groups. Data of patient gender, patient age of Kasai procedure, jaundice clearance, cholangitis after Kasai procedure and liver function indexes before liver transplantation were compared between three groups. The χ2 test, variance analysis, Kruskal-Wallis H test and multiple logistic regression analysis were used to find out the influencing factors for the survival time of autologous liver, that is, the influencing factors of early liver transplantation. Results There were no significant differences in gender and age of Kasai procedure between the three groups. There was statistical difference in the clearance of jaundice between the three groups (P＜0.01), showing a gradually increase from G1 to G3. There was significant difference in the early cholangitis between the three groups (P＜0.05), which was lower in G3 group than that of G1 group. There was significant difference in the late cholangitis after surgery between the three groups (P＜0.01), which was higher in G2 group than that of G1 group. There was statistical difference in the incidence of frequent cholangitis between the three groups (P＜0.05), which was lower in G3 group than that of G2 group. Multiple logistic regression analysis showed that persistent jaundice was the risk factor for native liver survival after Kasai procedure. Conclusion Persistent jaundice and early cholangitis after Kasai procedure can reduce the native liver survival time, which is related to the early liver transplantation. Persistent jaundice is a risk factor for early liver transplantation after Kasai procedure.

Key words: biliary atresia, liver transplantation, risk factors, Kasai procedure