Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL 60611-3211, USA.
Surgery. 2010 Oct;148(4):785-91; discussion 791-2. doi: 10.1016/j.surg.2010.07.028. Epub 2010 Aug 14.
Biliary atresia is a rare but devastating disease for which hepatoportoenterostomy remains the primary intervention. Increased age at the time of hepatoportoenterostomy is associated with unfavorable outcomes. In this study, we examined trends in age at the time of hepatoportoenterostomy and explored hospital and patient factors associated with more timely diagnosis and treatment.
Median ages of patients undergoing hepatoportoenterostomy for biliary atresia were compared using the Kids' Inpatients Database from 1997, 2000, 2003, and 2006. The patient and hospital factors associated with later treatment were compared.
Of 192 patients, 13.5% had surgery in 1997, 13.5% in 2000, 36.5% in 2003, and 36.5% in 2006. The overall median age was 65.5 days; the median age was 64 days in 1997, 57.5 days in 2000, 69 days in 2003, and 64 days in 2006 (P = .80). Overall, 71% of patients were treated at nonchildren's hospitals, and although the proportion has increased over time, the trend did not reach significance (P = .12). Hispanic and African American patients were more likely to undergo hepatoportoenterostomy after 60 days of life compared with white patients (Hispanic patients: odds ratio, 3.6; 95% confidence interval, 1.1-12.5; P = .04; African American patients: odds ratio, 2.2; 95% confidence interval, 0.8-6.3; P = .14). Compared with specialized children's centers, treatment at nonchildren's hospitals was associated with delayed hepatoportoenterostomy (odds ratio, 3.5; 95% confidence interval, 1.2-9.8; P = .02).
Although early hepatoportoenterostomy is associated with improved outcomes for children with biliary atresia, our study shows the median age at surgery has not significantly changed over 2 decades. Both hospital and socioeconomic factors play a role in the early treatment of biliary atresia.
胆道闭锁是一种罕见但严重的疾病，其主要治疗方法是肝门空肠吻合术。肝门空肠吻合术的年龄越大，预后越差。本研究旨在探讨胆道闭锁患儿行肝门空肠吻合术的年龄变化趋势，并分析与及时诊断和治疗相关的医院和患儿因素。
利用 1997 年、2000 年、2003 年和 2006 年的美国儿科住院患者数据库（Kids' Inpatients Database），比较胆道闭锁患儿行肝门空肠吻合术的年龄中位数。分析与较晚治疗相关的患儿和医院因素。
共纳入 192 例患儿，其中 13.5%的患儿于 1997 年、13.5%于 2000 年、36.5%于 2003 年、36.5%于 2006 年接受手术治疗。患儿的总体中位年龄为 65.5 天；1997 年、2000 年、2003 年和 2006 年的中位年龄分别为 64 天、57.5 天、69 天和 64 天（P =.80）。总体而言，71%的患儿在非儿童医院接受治疗，虽然该比例随时间推移有所增加，但无统计学意义（P =.12）。与白人患儿相比，西班牙裔和非裔美国患儿接受肝门空肠吻合术的时间晚于 60 天（西班牙裔患儿：比值比，3.6；95%置信区间，1.1-12.5；P =.04；非裔美国患儿：比值比，2.2；95%置信区间，0.8-6.3；P =.14）。与专科医院相比，在非儿童医院接受治疗与肝门空肠吻合术时间延迟相关（比值比，3.5；95%置信区间，1.2-9.8；P =.02）。
尽管早期肝门空肠吻合术可改善胆道闭锁患儿的预后，但本研究表明，20 余年来，患儿行肝门空肠吻合术的年龄中位数并无显著变化。医院和社会经济因素均会影响胆道闭锁的早期治疗。
