Department of Surgery, The Chinese University of Hong Kong, New Territories, Hong Kong.
Eur J Pediatr Surg. 2021 Aug;31(4):335-340. doi: 10.1055/s-0040-1713934. Epub 2020 Jul 6.
Age of patient and experience of biliary atresia (BA) center are well-known factors associated with early jaundice clearance (EJC) after Kasai portoenterostomy (KPE) in infants with BA. This study focused on the impact of age and surgeon factor on the short-term outcome after KPE within a single center.
Fifty-four consecutive infants (18 boys and 36 girls) who underwent KPE from January 2010 to January 2020 were reviewed. KPE was performed in the earliest available operative session once the initial work-up was completed. In group A ( = 41), KPE was performed by surgeon A. In group B ( = 13), KPE was performed by specialists under the supervision of surgeon B (who is the mentor of surgeon A) when surgeon A was not available for operation. The demographics of patients, the EJC (total bilirubin <20 μmol/L within 6 months of KPE), and 2-year native liver survival (NLS) between the two groups were studied.
The median age at operation was 52 days (range 26-135 days). The overall EJC rate and 2-year NLS were 85.2 and 89.4%, respectively. Group A ( = 0.015) and male gender ( = 0.029) were statistically associated with EJC but not the age at operation ( = 0.101). Group A was also statistically associated with superior 2-year NLS ( = 0.047).
Balancing between the impact of age at operation and the experience of surgeon on the outcome after KPE, our result suggested that KPE may be deferred until a more experienced surgeon to operate.
患者年龄和胆道闭锁（BA）中心的经验是与 BA 婴儿行Kasai 胆肠吻合术后（KPE）早期黄疸消退（EJC）相关的两个已知因素。本研究重点关注在单一中心内，年龄和外科医生因素对 KPE 短期结果的影响。
回顾了 2010 年 1 月至 2020 年 1 月期间在我院行 KPE 的 54 例连续婴儿（男 18 例，女 36 例）。一旦完成初始检查，就可尽早安排 KPE。在 A 组（n=41）中，KPE 由 A 外科医生进行。在 B 组（n=13）中，当 A 外科医生无法进行手术时，由 B 外科医生（A 外科医生的导师）指导下的专家进行 KPE。研究了两组患者的一般资料、EJC（KPE 后 6 个月内总胆红素<20μmol/L）和 2 年的固有肝存活率（NLS）。
手术时的中位年龄为 52 天（范围 26-135 天）。总体 EJC 率和 2 年 NLS 分别为 85.2%和 89.4%。A 组（P=0.015）和男性（P=0.029）与 EJC 有统计学相关性，但与手术时的年龄无统计学相关性（P=0.101）。A 组与 2 年 NLS 的相关性也更好（P=0.047）。
在 KPE 术后结果中，平衡手术时的年龄和外科医生经验的影响，我们的结果表明，KPE 可能会延迟到更有经验的外科医生进行操作。
