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先天性胆道闭锁患儿行 Kasai 手术后的生存预后因素分析。

Prognostic Factors for Survival of Patients with Biliary Atresia Following Kasai Surgery.

机构信息

Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.

出版信息

Kobe J Med Sci. 2020 Aug 17;66(2):E56-E60.

Abstract

Biliary atresia (BA) is a progressive obstruction and fibro-obliteration of the extrahepatic and intrahepatic biliary tract that causes cholestatic jaundice in infants, resulting in biliary cirrhosis and even death in the first year of life if the Kasai procedure is not performed at an earlier age. There are many prognostic factors that could affect the survival of patients with BA after Kasai surgery, however results still show some conflicting findings. A retrospective study was conducted using medical records of patients with BA who underwent Kasai surgery at Dr. Sardjito Hospital, Yogyakarta, Indonesia from June 2012 to April 2018. Twenty-nine BA patients were involved in our study, with 16 males and 13 females. Log-rank analysis showed a significant association between survival rate of BA patients with albumin level 1 month and 3 months after Kasai surgery, with p-values of 0.043 and 0.016, respectively. Interestingly, multivariate analysis revealed that cholangitis tended to have an association with BA patients' survival (p=0.09). In conclusion, the BA patients' survival might be affected by the presence of cholangitis after Kasai surgery. Further multicenter studies with a larger sample size are important to verify our results.

摘要

先天性胆道闭锁(BA)是一种进行性的肝外和肝内胆管阻塞和纤维性闭塞疾病,可导致婴儿出现胆汁淤积性黄疸,如果不在早期进行葛西手术,可导致胆汁性肝硬化,甚至在生命的第一年死亡。有许多预后因素可能会影响接受葛西手术后 BA 患者的生存,但结果仍存在一些相互矛盾的发现。本研究采用回顾性研究方法,分析了 2012 年 6 月至 2018 年 4 月在印度尼西亚日惹的萨德尔吉托医院接受葛西手术的 BA 患者的病历。本研究共纳入 29 例 BA 患者,其中男 16 例,女 13 例。对数秩分析显示,葛西手术后 1 个月和 3 个月时的白蛋白水平与 BA 患者生存率显著相关,p 值分别为 0.043 和 0.016。有趣的是,多变量分析显示胆管炎与 BA 患者的生存率有一定的关联(p=0.09)。总之,葛西手术后胆管炎的发生可能会影响 BA 患者的生存。需要进一步进行多中心、更大样本量的研究来验证我们的结果。

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