Calinescu Ana M, Madadi-Sanjani Omid, Mack Cara, Schreiber Richard A, Superina Riccardo, Kelly Deirdre, Petersen Claus, Wildhaber Barbara E
Division of Child's and Adolescent's Surgery, Swiss Pediatric Liver Center, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland.
Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany.
J Clin Med. 2022 Jan 19;11(3):494. doi: 10.3390/jcm11030494.
(1) Background: Acute cholangitis during the first year after Kasai hepatoportoenterostomy (HPE) has a negative impact on patient and native liver survival. There are no consistent guidelines for the definition, treatment, and prophylaxis of cholangitis after HPE. The aim of this study was to develop definition, treatment, and prophylaxis guidelines to allow for expeditious management and for standardization in reporting. (2) Methods: the Delphi method, an extensive literature review, iterative rounds of surveys, and expert panel discussions were used to establish definition, treatment, and prophylaxis guidelines for cholangitis in the first year after HPE. (3) Results: Eight elements (pooled into two groups: clinical and laboratory/imaging) were identified to define cholangitis after HPE. The final proposed definitions for suspected and confirmed cholangitis are a combination of one element, respectively, two elements from each group; furthermore, the finding of a positive blood culture was added to the definition of confirmed cholangitis. The durations for prophylaxis and treatment of suspected and confirmed cholangitis were uniformly agreed upon by the experts. (4) Conclusions: for the first time, an international consensus was found for guidelines for definition, treatment, and prophylaxis for cholangitis during the first year after Kasai HPE. Applicability will need further prospective multicentered studies.
(1) 背景：肝门空肠吻合术（HPE）后第一年发生的急性胆管炎对患者及自体肝存活有负面影响。目前对于HPE术后胆管炎的定义、治疗及预防尚无统一指南。本研究旨在制定定义、治疗及预防指南，以便能迅速进行管理并实现报告标准化。(2) 方法：采用德尔菲法、广泛的文献综述、多轮调查以及专家小组讨论，来制定HPE术后第一年胆管炎的定义、治疗及预防指南。(3) 结果：确定了八个要素（分为两组：临床及实验室/影像学）来定义HPE术后胆管炎。疑似和确诊胆管炎的最终拟定定义分别是每组各一个要素及两个要素的组合；此外，血培养阳性结果被纳入确诊胆管炎的定义。专家们就疑似和确诊胆管炎的预防及治疗时长达成了一致意见。(4) 结论：首次就肝门空肠吻合术后第一年胆管炎的定义、治疗及预防指南达成了国际共识。其适用性还需进一步的前瞻性多中心研究。
