Saeki M, Nakano M, Hagane K
Department of Surgery, National Children's Hospital, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1989 Sep;90(9):1353-6.
Postoperative complications which developed within three years after hepatic porto-jejunostomy (Kasai's operation) in 126 patients of biliary atresia were analyzed. Ascending cholangitis developed in 47 of 97 bile excreted patients. The excretion of bile ceased in another 18 patients without any symptom of cholangitis. Adhesive ileus, bleeding from the porta hepatis, wound dehiscence, and anastomotic leak developed less frequently. The mortality rate of the patients with these complications, especially with cholangitis or with cessation of the bile excretion, was extremely high; twenty nine (62%) out of 47 patients with cholangitis, and 14(78%) out of 18 patients with cessation of the bile excretion died. On the other hand, the mortality rate in 24 patients with bile excretion but without any postoperative complication was only 8% (2 patients). An intussusception type antireflux valve in the Roux-en-Y loop was effective for preventing cholangitis; cholangitis developed in none of 8 patients with an anti-reflux valve, whereas cholangitis developed in 25(48%) of recent 52 patients without a valve.
对126例胆道闭锁患者行肝门空肠吻合术（Kasai手术）后3年内出现的术后并发症进行了分析。97例胆汁排出患者中有47例发生上行性胆管炎。另有18例患者胆汁排泄停止，但无胆管炎症状。粘连性肠梗阻、肝门出血、伤口裂开和吻合口漏的发生率较低。出现这些并发症的患者，尤其是胆管炎或胆汁排泄停止的患者，死亡率极高；47例胆管炎患者中有29例（62%）死亡，18例胆汁排泄停止的患者中有14例（78%）死亡。另一方面，24例胆汁排泄但无任何术后并发症的患者死亡率仅为8%（2例）。Roux-en-Y袢中的套叠式抗反流瓣膜对预防胆管炎有效；8例有抗反流瓣膜的患者均未发生胆管炎，而最近52例无瓣膜的患者中有25例（48%）发生了胆管炎。
