Ⅲ型胆道闭锁患儿肝门肠吻合术预后相关因素分析

doi:10.3969/j.issn.1674-8115.2021.09.002

摘要/Abstract

摘要：

目的·探讨影响Ⅲ型胆道闭锁患儿肝门肠吻合术（又称为Kasai手术）术后黄疸清除及自体肝生存的相关因素。方法·回顾性分析2012年1月—2018年1月中国医科大学附属盛京医院收治的Ⅲ型胆道闭锁并行Kasai手术患儿的临床资料，根据患儿预后情况将其分为黄疸清除组（JC组，又分为早期退黄组和晚期退黄组）和黄疸未清除组（JOC组），或自体肝生存组和非自体肝生存组（肝移植/死亡）。应用t检验/U检验、χ²检验、Kaplan-Meier生存分析、多因素Cox回归分析等统计学方法，分析影响预后的相关因素。结果·共有96例临床资料及随访资料完整的Ⅲ型胆道闭锁患儿被纳入研究，其中男、女各48例；平均手术日龄为（62.1±18.9）d，平均随访时间为（16.2±20.3）个月。61例（63.5%）患儿在术后6个月内直接胆红素降至正常水平（JC组）；与JOC组相比，JC组术前间接胆红素水平较高，而白蛋白水平较低（均P<0.05）。Kaplan-Meier生存曲线分析结果显示，术后3、6、12、24个月所有患儿自体肝生存率分别为92.3%、70.9%、57.8%和55.8%；JC组的自体肝生存率显著高于JOC组（P=0.000），早期退黄组显著高于晚期退黄组（P=0.001）。多因素Cox回归分析结果发现，影响自体肝生存率的相关因素为性别及黄疸是否清除，男性［P=0.049，RR=2.163（95%CI 1.076~4.797）］、黄疸消退［P=0.001，RR=11.488（95%CI 2.726~48.415）］患儿的2年自体肝生存率较高。结论·术前间接胆红素水平和白蛋白水平可能与Ⅲ型胆道闭锁并行Kasai手术患儿术后黄疸清除有关；男性、黄疸消退是这类患儿2年自体肝生存的保护因素。

关键词: Ⅲ型胆道闭锁, 肝门肠吻合术（Kasai手术）, 黄疸清除, 自体肝生存

Abstract:

Objective·To explore the factors related to the jaundice clearance and native liver survival after portoenterostomy (Kasai's operation) in the children with type Ⅲ biliary atresia.

Methods·The clinical data of the patients diagnosed as having type Ⅲ biliary atresia, who underwent Kasai's operation in Shengjing Hospital of China Medical University from January 2012 to January 2018, were analyzed retrospectively. According to the prognosis, the children were divided into jaundice clearance group (JC group, which was divided further into early and late JC group) and jaundice non-clearing group (JOC group), or native liver survival group and non-native liver survival group (liver transplantation/death). T/U test, χ² test, Kaplan-Meier survival analysis, and multivariate Cox regression analysis were employed to analyze the prognostic factors.

Results·A total of 96 patients were enrolled in this study, including 48 males and 48 females. The average age of operation was (62.1±18.9) d, and the average follow-up time was (16.2±20.3) months. Direct bilirubin decreased to normal within 6 months postoperatively in 61 cases (63.5%). Compared with the JOC group, the indirect bilirubin (IBIL) level was higher and the albumin level was lower in the JC group before operation (both P<0.05). The result of Kaplan-Meier survival curve analysis showed that the native liver survival rates at 3, 6, 12 and 24 months after operation were 92.3%, 70.9%, 57.8% and 55.8%, respectively. The native liver survival rate of the JC group was higher than that of the JOC group (P=0.000). The rate was also higher in the early JC group when compared with the late JC group (P=0.001). Multivariate Cox regression analysis revealed that gender of male [P=0.049, RR=2.163 (95%CI 1.076?4.797)] and jaundice clearance [P=0.001, RR=11.488 (95%CI 2.726?48.415)] were the protective factors of 2-year native liver survival rate.

Conclusion·Preoperative IBIL and albumin levels may affect jaundice clearance in the children with type Ⅲ biliary atresia after portoenterostomy; gender of male and jaundice clearance are protective factors for 2-year native liver survival in these children.

Key words: type Ⅲ biliary atresia, portoenterostomy (Kasai's operation), jaundice clearance, native liver survival

中图分类号:

R726

吉耿锋, 张志波. Ⅲ型胆道闭锁患儿肝门肠吻合术预后相关因素分析[J]. 上海交通大学学报(医学版), 2021, 41(9): 1142-1146.

Geng-feng JI, Zhi-bo ZHANG. Factors related to prognosis of portoenterostomy for type Ⅲ biliary atresia[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(9): 1142-1146.

图/表 4

表1 JC组与JOC组之间术前临床指标的差异

Tab 1 Differences of clinical indexes before operations between the JC group and JOC group

Index	JC group （n=61）	JOC group （n=35）	P value
Operation age/d	60.7±17.9	66.3±20.3	0.164
CMV-IgM/n（%）			0.549
+	48 （78.7）	28 （80.0）
-	13 （21.3）	7 （20.0）
GGT/（U·L^-1）	690.4±478.0	724.3±546.8	0.458
GPT/（U·L^-1）	122.1±78.5	135.0±84.6	0.812
GOT/（U·L^-1）	190.5±124.3	222.3±122.7	0.721
DBIL/（μmol·L^-1）	126.0±50.7	130.9±40.1	0.275
IBIL/（μmol·L^-1）	51.2±48.9	35.9±15.7	0.025
TBA/（μmol·L^-1）	135.2±74.3	150.2±69.4	0.830
Alb/（g·L^-1）	39.9±4.1	40.3±2.5	0.020

图1 96例BA患儿自体肝生存曲线

Fig 1 Native liver survival curve of 96 BA patients

图2 JC组和JOC组自体肝生存曲线的比较

Fig 2 Comparison of native liver survival curves between the JC group and JOC group

图3 早期退黄组和晚期退黄组自体肝生存曲线的比较

Fig 3 Comparison of native liver survival curves between the early JC group and late JC group

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