Arii Rumi, Koga Hiroyuki, Arakawa Atsushi, Miyahara Katsumi, Lane Geoffrey J, Okazaki Tadaharu, Urao Masahiko, Yamataka Atsuyuki
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Pediatr Surg Int. 2011 Mar;27(3):275-7. doi: 10.1007/s00383-010-2793-0.
We assessed ductal plate malformation (DPM) as a prognostic factor for mid-/long-term outcome in post-hepatoportoenterostomy (HPE) biliary atresia patients.
Of 78 cases of HPE performed between 1989 and 2009, biopsy specimens were available for 43. Cytokeratin 19 was used to identify DPM and preoperative status, postoperative serum total bilirubin, time taken to become jaundice-free, duration of jaundice-free period, steroid usage, incidences of cholangitis, bile lakes, and varices, and requirement for reoperation and liver transplantation were compared.
DPM was detected in 21/43 (48.8%) subjects [DPM-positive (DPM+)]. Differences were identified for maximum postoperative serum total bilirubin: DPM+ (12.28 ± 1.00 mg/dL) versus DPM-negative (DPM-) (9.67 ± 0.71 mg/dL) (P < 0.05) and total steroid usage: DPM+ (98.3 ± 11.8 mg/kg) versus DPM- (83.4 ± 15.9 mg/kg) (P = NS). However, total steroid dose in jaundice-free cases was significantly higher in DPM+ [75.3 ± 10.0 mg/kg (n = 14) vs. 48.1 ± 6.4 mg/kg (n = 19); P < 0.05)]. There were no differences for complications. Mean duration of follow-up was significantly shorter for DPM+ (60.9 ± 38.4 vs. 113.8 ± 56.9 months; P < 0.05).
Postoperative total bilirubin was higher in DPM+ cases, thus higher doses of steroids were required. However, DPM+ did not appear to influence the incidence of complications mid-/long-term.
我们评估了导管板畸形（DPM）作为肝门空肠吻合术（HPE）后胆道闭锁患者中长期预后的一个预后因素。
在1989年至2009年间进行的78例HPE病例中，43例有活检标本。使用细胞角蛋白19来识别DPM，并比较术前状态、术后血清总胆红素、黄疸消退时间、无黄疸期持续时间、类固醇使用情况、胆管炎、胆汁湖和静脉曲张的发生率以及再次手术和肝移植的需求。
在21/43（48.8%）的受试者中检测到DPM [DPM阳性（DPM+）]。术后血清总胆红素最大值存在差异：DPM+（12.28±1.00mg/dL）与DPM阴性（DPM-）（9.67±0.71mg/dL）（P<0.05），以及总类固醇使用量：DPM+（98.3±11.8mg/kg）与DPM-（83.4±15.9mg/kg）（P=无显著性差异）。然而，无黄疸病例中DPM+的总类固醇剂量显著更高[75.3±10.0mg/kg（n=14）对48.1±6.4mg/kg（n=19）；P<0.05]。并发症方面无差异。DPM+的平均随访时间显著更短（60.9±38.4对113.8±56.9个月；P<0.05）。
DPM+病例术后总胆红素更高，因此需要更高剂量的类固醇。然而，DPM+似乎并未影响中长期并发症的发生率。
