腹腔镜下胆管闭锁肝门空肠吻合术后预后的综合评估
Comprehensive assessment of prognosis after laparoscopic portoenterostomy for biliary atresia.
作者信息
Nakamura Hiroki, Koga Hiroyuki, Cazares Joel, Okazaki Tadaharu, Lane Geoffrey J, Miyano Go, Okawada Manabu, Doi Takashi, Urao Masahiko, Yamataka Atsuyuki
机构信息
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Department of Pediatric Surgery, Hospital Regional de Alta Especialidad Materno Infantil, Monterrey, Mexico.
出版信息
Pediatr Surg Int. 2016 Feb;32(2):109-12. doi: 10.1007/s00383-015-3820-y. Epub 2015 Oct 31.
PURPOSE
Total bilirubin (T-bil) is used universally for monitoring post-portoenterostomy (PE) biliary atresia (BA) patients although other biochemical markers [BM; AST/ALT and platelet count (PC)] are also prognostic. We compared open PE (OPE) with laparoscopic PE (LPE) using T-bil, AST/ALT, and PC (3BM) as more comprehensive indicators of postoperative clinical status.
METHODS
Subjects were 31 PE cases (LPE: n = 17; OPE: n = 14). BA classification was type III (n = 16), type II (n = 1) in LPE and type III (n = 12), type I (n = 1), type II (n = 1) in OPE.
RESULTS
Mean ages and weights at PE were similar: 65.5 days, 4.4 kg (LPE) versus 69.3 days, 4.1 kg (OPE); and mean follow-up was 2.5 years for both LPE and OPE. Jaundice clearance (T-bil ≤1.2 mg/dL) was achieved in 16/17 (94.1 %) after LPE versus 10/14 (71.4 %) after OPE (p = NS), but 3BM were closer to normal after OPE. At the time of review, 13/17 LPE cases (76.5 %) were alive with native livers and 4/17 had received LTx (23.5 %) and 10/14 OPE cases (71.4 %) were alive with native livers and 4/14 had received LTx (28.6 %).
CONCLUSIONS
Although JC was better after LPE, 3BM were better after OPE. Further follow-up will prove the comprehensive prognostic value of 3BM.
目的
尽管其他生化指标[如天冬氨酸氨基转移酶/丙氨酸氨基转移酶（AST/ALT）和血小板计数（PC）]也具有预后价值，但总胆红素（T-bil）仍被广泛用于监测肝门空肠吻合术（PE）后胆道闭锁（BA）患者的病情。我们以T-bil、AST/ALT和PC（3项生化指标）作为术后临床状况更全面的指标，比较了开放式PE（OPE）和腹腔镜PE（LPE）。
方法
研究对象为31例行PE手术的患者（LPE组：n = 17；OPE组：n = 14）。LPE组中BA分型为III型（n = 16）、II型（n = 1），OPE组中BA分型为III型（n = 12）、I型（n = 1）、II型（n = 1）。
结果
PE手术时的平均年龄和体重相似：LPE组为65.5天、4.4千克，OPE组为69.3天、4.1千克；LPE组和OPE组的平均随访时间均为2.5年。LPE术后16/17例（94.1%）黄疸消退（T-bil≤1.2mg/dL），OPE术后10/14例（71.4%）黄疸消退（p = 无显著性差异），但OPE术后3项生化指标更接近正常水平。复查时，LPE组13/17例（76.5%）存活且肝脏为自身肝脏，4/17例接受了肝移植（LTx，23.5%）；OPE组10/14例（71.4%）存活且肝脏为自身肝脏，4/14例接受了肝移植（28.6%）。
结论
尽管LPE术后黄疸消退情况更好，但OPE术后3项生化指标表现更佳。进一步随访将证实3项生化指标的综合预后价值。
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