比较分析儿童活体肝移植治疗胆道闭锁行开腹与腹腔镜下 Kasai 门腔分流术的效果。

Comparative study of open and laparoscopic Kasai portoenterostomy in children undergoing living donor liver transplantation for biliary atresia.

机构信息

Organ Transplantation Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.

Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Pediatr Surg Int. 2021 Dec;37(12):1683-1691. doi: 10.1007/s00383-021-04994-z. Epub 2021 Aug 28.

DOI:10.1007/s00383-021-04994-z

PMID:34453589

Abstract

PURPOSE

The effectiveness of laparoscopic Kasai portoenterostomy (Laparoscopic-KPE) for biliary atresia (BA) has been reported but remains controversial. We reviewed our own cases and cases described in previous studies of liver transplantation (LT) for BA after Laparoscopic-KPE to investigate the efficacy of Laparoscopic-KPE.

METHODS

Subjects were children of ≤ 2 years old with LT for BA after KPE who underwent Laparoscopic-KPE (n = 10) or Open-KPE (n = 115) between 2009 and 2020. Propensity score matching was performed to reduce the effect of treatment selection bias. The clinical data regarding the preoperative characteristics and surgical results were compared.

RESULTS

The rates of hypoplastic portal vein and retrograde portal vein flow were lower in the Laparoscopic-KPE group than in the Open-KPE group (0 vs. 40.0%, p = 0.02 and 0 vs. 35.0%, p = 0.04). There was no marked difference in the operation time or duration of hepatectomy. For portal vein reconstruction, a vein graft was not required in the Laparoscopic-KPE group (0 vs. 35.0%, p = 0.03). No patients in the Laparoscopic-KPE group developed portal vein complications or required re-laparotomy for bowel perforation or re-bleeding, in contrast to the Open-KPE group (0 vs. 15.0% and 0 vs. 10.0%, respectively).

CONCLUSION

Laparoscopic-KPE may reduce postoperative complications that necessitate re-laparotomy in LT.

摘要

目的

腹腔镜胆肠吻合术（Laparoscopic-KPE）治疗胆道闭锁（BA）的有效性已有报道，但仍存在争议。我们回顾了我们自己的病例和之前报道的经 Laparoscopic-KPE 行肝移植（LT）治疗 BA 的病例，以研究 Laparoscopic-KPE 的疗效。

方法

研究对象为 2009 年至 2020 年间经 KPE 后因 BA 而行 LT 的年龄≤2 岁的儿童，这些儿童接受了 Laparoscopic-KPE（n=10）或 Open-KPE（n=115）。采用倾向评分匹配法减少治疗选择偏倚的影响。比较了术前特征和手术结果的临床数据。

结果

Laparoscopic-KPE 组的发育不良门静脉和逆行门静脉血流的发生率低于 Open-KPE 组（0 比 40.0%，p=0.02 和 0 比 35.0%，p=0.04）。手术时间或肝切除术持续时间无显著差异。对于门静脉重建，Laparoscopic-KPE 组不需要静脉移植物（0 比 35.0%，p=0.03）。与 Open-KPE 组相比，Laparoscopic-KPE 组没有患者发生门静脉并发症或需要因肠穿孔或再出血而再次剖腹手术（0 比 15.0%和 0 比 10.0%）。