Yassin Noha Adel, El-Tagy Gamal, Abdelhakeem Omar Nagy, Asem Noha, El-Karaksy Hanaa
Department of Pediatrics, Cairo University, Cairo, Egypt.
Department of Pediatric Surgery, Cairo University, Cairo, Egypt.
Pediatr Gastroenterol Hepatol Nutr. 2020 May;23(3):266-275. doi: 10.5223/pghn.2020.23.3.266. Epub 2020 May 13.
The outcome predictors of Kasai portoenterostomy (KPE) for biliary atresia (BA) are controversial. This study aimed to identify possible short-term outcome predictors of KPE for BA in infants.
This retrospective study included infants with BA who underwent KPE between January 2015 and December 2017 and were followed up for at least 6 months after surgery at the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Egypt. The short-term outcome was jaundice clearance within 6 months following surgery. All data were compared between the jaundice free group and those with persistent jaundice to identify the predictors of jaundice clearance.
The study included 75 infants. The mean age at the time of surgery was 82.43±22.77 days (range, 37-150 days), and 28 (37.3%) infants cleared their jaundice within 6 months postoperative. Age at surgery did not significantly affect the outcome (=0.518). Infants with persistent jaundice had significantly higher pre-operative levels of aspartate aminotransferase (AST) than those who were jaundice free (=0.041). Receiver operating characteristic curve analysis showed that preoperative AST ≤180 IU/L was predictive of a successful KPE, with sensitivity 74.5% and specificity 60.7%. Infants with bile plugs in liver biopsy had a 6-fold higher risk of persistent jaundice than those without bile plugs (95% confidence interval: 1.59-20.75, =0.008).
Jaundice clearance after KPE for BA can be predicted using preoperative AST and presence of bile plugs in liver biopsy.
对于胆道闭锁（BA）行肝门空肠吻合术（KPE）的预后预测因素存在争议。本研究旨在确定婴儿BA行KPE可能的短期预后预测因素。
这项回顾性研究纳入了2015年1月至2017年12月期间接受KPE的BA婴儿，并在埃及开罗大学儿童医院儿科肝病科术后至少随访6个月。短期预后是术后6个月内黄疸消退情况。将所有数据在无黄疸组和持续性黄疸组之间进行比较，以确定黄疸消退的预测因素。
该研究纳入了75名婴儿。手术时的平均年龄为82.43±22.77天（范围37 - 150天），28名（37.3%）婴儿在术后6个月内黄疸消退。手术年龄对预后无显著影响（P = 0.518）。持续性黄疸婴儿术前天冬氨酸转氨酶（AST）水平显著高于无黄疸婴儿（P = 0.041）。受试者工作特征曲线分析显示，术前AST≤180 IU/L可预测KPE成功，敏感性为74.5%，特异性为60.7%。肝活检有胆栓的婴儿持续性黄疸风险比无胆栓婴儿高6倍（95%置信区间：1.59 - 20.75，P = 0.008）。
BA行KPE术后黄疸消退情况可通过术前AST和肝活检中胆栓的存在来预测。
