Schoen B T, Lee H, Sullivan K, Ricketts R R
Departments of Gastroenterology and Surgery, Children's Healthcare of Atlanta at Egleston, Emory University, Atlanta, GA, USA.
J Pediatr Surg. 2001 Jan;36(1):97-9. doi: 10.1053/jpsu.2001.20020.
BACKGROUND/PURPOSE: Kasai portoenterostomy is recommended as the primary initial therapy for extrahepatic biliary atresia if the procedure can be performed within 10 to 12 weeks of life. The optimal management for infants with delayed presentation of biliary atresia remains controversial. The purpose of this study was to determine the success rate and outcome for patients who underwent a "late" Kasai portoenterostomy.
The authors conducted a retrospective review of the medical records of all patients with biliary atresia who underwent a Kasai portoenterostomy at their institution from 1986 to 1999 (n = 31). The authors analyzed success rates compared with age at the time of the Kasai procedure and the association with patient demographics. Surgical success was defined as achievement of a total serum bilirubin < or = 2 mg/dL. Long-term follow-up assessments included the need for liver transplantation and patient survival rate.
The demographics of this study cohort showed a predominance of African-Americans, 19 of 31 (61%), and girls, 23 of 31 (74%). Assessment of success compared with subject age at the time of the initial portoenterostomy showed that 52% (13 of 25) had successful Kasai procedure at 0 to 75 days, compared with 83% success rate (5 of 6) at age 76 days or older (P = .359). Liver transplantation was performed in 16 of 31 patients (45%). Overall survival rate for the entire cohort is 23 of 31 (74%), whereas 12 of 31 (39%) are currently alive without a liver transplant.
These data suggest that there is no contraindication to performing a Kasai portoenterostomy for biliary atresia in children over 75 days of age.
背景/目的：如果能在出生后10至12周内进行手术，肝门空肠吻合术被推荐作为肝外胆道闭锁的主要初始治疗方法。对于胆道闭锁延迟就诊婴儿的最佳治疗方案仍存在争议。本研究的目的是确定接受“晚期”肝门空肠吻合术患者的成功率和预后。
作者对1986年至1999年在其机构接受肝门空肠吻合术的所有胆道闭锁患者的病历进行了回顾性研究（n = 31）。作者分析了与肝门空肠吻合术时年龄相关的成功率以及与患者人口统计学特征的关联。手术成功定义为血清总胆红素≤2mg/dL。长期随访评估包括肝移植需求和患者生存率。
本研究队列的人口统计学特征显示非裔美国人占主导，31例中有19例（61%），女孩占主导，31例中有23例（74%）。将初始肝门空肠吻合术时的成功情况与受试者年龄进行比较评估，结果显示，0至75天时接受肝门空肠吻合术的患者中52%（25例中的13例）手术成功，而76天及以上患者的成功率为83%（6例中的5例）（P = 0.359）。31例患者中有16例（45%）接受了肝移植。整个队列的总体生存率为31例中的23例（74%），而31例中有12例（39%）目前未进行肝移植且存活。
这些数据表明，对于75天以上的儿童，进行肝门空肠吻合术治疗胆道闭锁没有禁忌证。
