Tianjin First Center Hospital, Key Laboratory of Organ Transplant of Tianjin, China.
Tianjin First Center Hospital, Key Laboratory of Organ Transplant of Tianjin, China.
J Pediatr Surg. 2019 Jul;54(7):1436-1439. doi: 10.1016/j.jpedsurg.2018.07.022. Epub 2018 Aug 29.
To evaluate the effects of Kasai procedure (hepatic portoenterostomy) on living donor liver transplantation (LDLT) for children with biliary atresia (BA).
From January 2006 to January 2014, 150 children with BA were treated with LDLT in China. The children were categorized into pre-Kasai and non-Kasai groups, based on whether they had previously undergone Kasai procedure. Clinical data were retrospectively analyzed, and the difference in postoperative survival was compared between the groups. Preoperative data, including height, weight, serum bilirubin, and pediatric end-stage liver disease score, and perioperative blood loss, operation duration, incidence of postoperative surgical complications including vascular complications, bile duct complications, lymphatic fluid leakage, and digestive tract fistula were compared between the groups.
In total, 89 and 61 children were categorized in the pre-Kasai and non-Kasai groups, respectively. The 1-, 6-, and 12-month survival was 97.8%, 95.4%, and 95.4% for the Kasai group, and 98.4%, 96.7%, and 96.7% for the non-Kasai group, respectively (P > 0.05). The differences in mean operation duration and mean blood loss, and the incidences of outflow tract obstruction, portal vein stenosis, hepatic artery thrombosis, bile duct complications, lymphatic fluid leakage, and digestive tract fistula were not statistically significant between the groups (P > 0.05).
Kasai procedure could effectively delay the requirement of liver transplantation. In light of previous findings that Kasai procedure could significantly improve the liver transplantation-free survival of children with BA, we suggest that Kasai procedure should be used as a first-line treatment method for this condition.
Treatment Study.
Level III.
评估葛西术（肝门肠吻合术）对胆道闭锁（BA）患儿活体肝移植（LDLT）的影响。
2006 年 1 月至 2014 年 1 月，中国有 150 例 BA 患儿接受 LDLT 治疗。根据患儿是否行葛西术，将其分为葛西术前组和非葛西术前组。回顾性分析临床资料，比较两组患儿术后生存率的差异。比较两组患儿术前身高、体重、血清胆红素、小儿终末期肝病评分、围手术期出血量、手术时间、血管并发症、胆漏、吻合口狭窄、淋巴漏、消化道瘘等术后手术并发症的发生率。
共 89 例患儿归入葛西术前组，61 例归入非葛西术前组。葛西术前组患儿 1、6、12 个月生存率分别为 97.8%、95.4%、95.4%，非葛西术前组患儿分别为 98.4%、96.7%、96.7%（P＞0.05）。两组患儿手术时间、术中出血量、肝外胆管流出道梗阻、门静脉狭窄、肝动脉血栓形成、胆漏、吻合口狭窄、淋巴漏、消化道瘘发生率的差异均无统计学意义（P＞0.05）。
葛西术能有效延迟患儿对肝移植的需求。鉴于葛西术能显著提高 BA 患儿肝移植无失败生存率的既往研究结果，我们建议将葛西术作为 BA 的一线治疗方法。
治疗性研究。
Ⅲ级。
