Abdel-Aziz Samira Abdel-Wahab, Sira Mostafa Mohamad, Gad Emad Hamdy, Ayoub Islam, Soltan Mervat
Department of Pediatric Hepatology, Gastroenterology and Nutrition, National Liver Institute, Menoufia Universtiy, Egypt.
Department of Hepatopancreaticobiliary Surgery, National Liver Institute, Menoufia Universtiy, Egypt.
Clin Exp Hepatol. 2019 May;5(2):155-160. doi: 10.5114/ceh.2019.85072. Epub 2019 May 13.
Biliary atresia (BA) is a fibro-inflammatory cholangiopathy of intra- and extrahepatic biliary radicles. The standard-of-care treatment is surgical restoration of bile flow by Kasai hepatoportoenterostomy (HPE). We aimed to identify the predictors of short-term outcome of the Kasai operation three months postoperatively.
This retrospective study included 107 infants diagnosed with BA by intraoperative cholangiography. All underwent a Kasai operation. The surgical outcome was classified after 3 months post-operatively as successful (bilirubin ≤ 2 mg/dl) or failed (bilirubin > 2 mg/dl). The two groups were compared according to basic clinical, ultrasonographic and histopathological characteristics.
Of the studied patients 29 (27.1%) had a successful outcome while 78 (72.9%) had failed Kasai HPE. Of the preoperative characteristics, lower age and lower serum alkaline phosphatase (ALP) were significantly associated with successful surgical outcome ( = 0.009 and < 0.0001, respectively). In addition, surgical type of BA affected the short-term outcome ( = 0.017), while there was no statistically significant difference regarding the other studied parameters between groups. Age of 69.5 days or less was predictive of successful outcome with 74.4% specificity but with low sensitivity (58.6%), and ALP at a cutoff level of 532.5 U/l or less was predictive of successful outcome with 75.9% sensitivity and 74.4% specificity.
Younger age at the time of surgery and lower ALP are good predictors for the short-term outcome of Kasai HPE with better performance of ALP. This may help to anticipate those who can benefit from surgical correction and those who should be given high priority for transplant referral.
胆道闭锁（BA）是一种肝内和肝外胆管分支的纤维炎性胆管病。标准治疗方法是通过Kasai肝门肠吻合术（HPE）手术恢复胆汁流动。我们旨在确定Kasai手术后三个月短期预后的预测因素。
这项回顾性研究纳入了107例经术中胆管造影诊断为BA的婴儿。所有患儿均接受了Kasai手术。术后3个月将手术结果分为成功（胆红素≤2mg/dl）或失败（胆红素>2mg/dl）。根据基本临床、超声和组织病理学特征对两组进行比较。
在研究的患者中，29例（27.1%）手术结果成功，而78例（72.9%）Kasai HPE手术失败。在术前特征中，较低的年龄和较低的血清碱性磷酸酶（ALP）与手术成功结果显著相关（分别为P = 0.009和P < 0.0001）。此外，BA的手术类型影响短期预后（P = 0.017），而两组之间其他研究参数在统计学上无显著差异。69.5天及以下的年龄预测成功结果的特异性为74.4%，但敏感性较低（58.6%），ALP临界值为532.5 U/l及以下预测成功结果的敏感性为75.9%，特异性为74.4%。
手术时年龄较小和ALP较低是Kasai HPE短期预后的良好预测因素，且ALP表现更佳。这可能有助于预测哪些患者能从手术矫正中获益，以及哪些患者应被优先转诊进行移植。
