上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2021 , Vol. 41 >Issue 9: 1142 - 1146

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.09.002

新生儿外科专题

Ⅲ型胆道闭锁患儿肝门肠吻合术预后相关因素分析

  • 吉耿锋 ,
  • 张志波
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  • 中国医科大学附属盛京医院小儿外科，沈阳 110003
吉耿锋（1994—），男，硕士生；电子信箱：1677373565@qq.com。
张志波，电子信箱：zhangzb@sj-hospital.org。

收稿日期: 2021-03-15

  网络出版日期: 2021-08-24

基金资助

国家自然科学基金(81270437);辽宁省科技厅省重点研发计划(2017225014)

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Factors related to prognosis of portoenterostomy for type Ⅲ biliary atresia

  • Geng-feng JI ,
  • Zhi-bo ZHANG
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  • Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang 110003, China
ZHANG Zhi-bo, E-mail: zhangzb@sj-hospital.org.

Received date: 2021-03-15

  Online published: 2021-08-24

Supported by

National Natural Science Foundation of China(81270437);Key R&D Project of Science and Technology Department of Liaoning Province(2017225014)

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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

本文引用格式

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 . DOI: 10.3969/j.issn.1674-8115.2021.09.002

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

参考文献

1 Tam PKH, Chung PHY, St Peter SD, et al. Advances in paediatric gastroenterology[J]. Lancet, 2017, 390(10099): 1072-1082.
2 Nizery L, Chardot C, Sissaoui S, et al. Biliary atresia: clinical advances and perspectives[J]. Clin Res Hepatol Gastroenterol, 2016, 40(3): 281-287.
3 Hopkins PC, Yazigi N, Nylund CM. Incidence of biliary atresia and timing of hepatoportoenterostomy in the United States[J]. J Pediatr, 2017, 187: 253-257.
4 Chung PHY, Zheng S, Tam PKH. Biliary atresia: east versus west[J]. Semin Pediatr Surg, 2020, 29(4): 150950.
5 Scottoni F, Davenport M. Biliary atresia: potential for a new decade[J]. Semin Pediatr Surg, 2020, 29(4): 150940.
6 Jimenez-Rivera C, Jolin-Dahel KS, Fortinsky KJ, et al. International incidence and outcomes of biliary atresia[J]. J Pediatr Gastroenterol Nutr, 2013, 56(4): 344-354.
7 Okubo R, Nio M, Sasaki H, et al. Impacts of early Kasai portoenterostomy on short-term and long-term outcomes of biliary atresia[J]. Hepatol Commun, 2021, 5(2): 234-243.
8 Wang J, Xu Y, Chen Z, et al. Liver immune profiling reveals pathogenesis and therapeutics for biliary atresia[J]. Cell, 2020, 183(7): 1867-1883.e26.
9 Liu Y, Peng C, Wang K, et al. The utility of shear wave elastography and serum biomarkers for diagnosing biliary atresia and predicting clinical outcomes[J]. Eur J Pediatr, 2021. DOI: 10.1007/s00431-021-04176-y.
10 Capparelli MA, Ayarzabal VH, Halac ET, et al. Preoperative risk factors for the early failure of the Kasai portoenterostomy in patients with biliary atresia[J]. Pediatr Surg Int, 2021. DOI: 10.1007/s00383-021-04933-y.
11 Chung PHY, Chan EKW, Yeung F, et al. Life long follow up and management strategies of patients living with native livers after Kasai portoenterostomy[J]. Sci Rep, 2021, 11(1): 11207
12 中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 实用肝脏病杂志, 2020, 23(1): 9-32.
13 Davenport M. Biliary atresia: clinical aspects[J]. Semin Pediatr Surg, 2012, 21(3): 175-184.
14 Bezerra JA, Wells RG, Mack CL, et al. Biliary atresia: clinical and research challenges for the twenty-first century[J]. Hepatology, 2018, 68(3): 1163-1173.
15 Wong CWY, Chung PHY, Tam PKH, et al. Long-term results and quality of life assessment in biliary atresia patients: a 35-year experience in a tertiary hospital[J]. J Pediatr Gastroenterol Nutr, 2018, 66(4): 570-574.
16 Davenport M, Caponcelli E, Livesey E, et al. Surgical outcome in biliary atresia: etiology affects the influence of age at surgery[J]. Ann Surg, 2008, 247(4): 694-698.
17 Gu YH, Matsui A. Long-term native liver survival in infants with biliary atresia and use of a stool color card: case-control study[J]. Pediatr Int, 2017, 59(11): 1189-1193.
18 Bove KE, Thrasher AD, Anders R, et al. Inflammation, active fibroplasia, and end-stage fibrosis in 172 biliary atresia remnants correlate poorly with age at Kasai portoenterostomy, visceral heterotaxy, and outcome[J]. Am J Surg Pathol, 2018, 42(12): 1625-1635.
19 Hartley JL, Davenport M, Kelly DA. Biliary atresia[J]. Lancet, 2009, 374(9702): 1704-1713.
20 Zani A, Quaglia A, Hadzi? N, et al. Cytomegalovirus-associated biliary atresia: an aetiological and prognostic subgroup[J]. J Pediatr Surg, 2015, 50(10): 1739-1745.
21 Mack CL. The pathogenesis of biliary atresia: evidence for a virus-induced autoimmune disease[J]. Semin Liver Dis, 2007, 27(3): 233-242.
22 Parolini F, Hadzic N, Davenport M. Adjuvant therapy of cytomegalovirus IgM+ve associated biliary atresia: prima facie evidence of effect[J]. J Pediatr Surg, 2019, 54(9): 1941-1945.
23 Wang ZM, Chen YJ, Peng CH, et al. Five-year native liver survival analysis in biliary atresia from a single large Chinese center: the death/liver transplantation hazard change and the importance of rapid early clearance of jaundice[J]. J Pediatr Surg, 2019, 54(8): 1680-1685.
24 Witt M, van Wessel DBE, de Kleine RHJ, et al. Prognosis of biliary atresia after 2-year survival with native liver: a nationwide cohort analysis[J]. J Pediatr Gastroenterol Nutr, 2018, 67(6): 689-694.
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