Liu Fei, Xu Xiaogang, Liang Zijian, Tao Boyuan, Lan Menglong, Zeng Jixiao
Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China.
Front Pediatr. 2023 Jul 12;11:1189792. doi: 10.3389/fped.2023.1189792. eCollection 2023.
To explore the outcomes and related factors in children without cholangitis after Kasai portoenterostomy (KPE).
We retrospectively analyzed the data of infants with type III BA who underwent KPE from June 2016 to December 2021. We compared and analyzed the difference in native liver survival (NLS) rates in different types of cholangitis. We also investigated the relationship between the absence of cholangitis and the effect of early bile drainage (EBD) as well as the related factors affecting EBD efficacy.
A total of 145 children were included in this study. Among these children, 82 (56.6%, 82/145) had cholangitis, including 40 (48.8%, 40/82) with early cholangitis and 33 (40.2%, 33/82) with recurrent cholangitis. The median follow-up period was 29 months (range, 2-75 months). The NLS rates were 67.6%, 51.7%, 45.5% and 43.4% at 6 months, 1 year, 2 years and 5 years following KPE, while the NLS rates for infants without cholangitis after KPE were 68.3%, 50.8%, 46.0% and 46.0%, respectively. Higher gamma-glutamyl transferase (γ- GT) and total bile acid (TBA) before KPE were risk factors for cholangitis (< 0.05). The NLS rate in recurrent cholangitis was significantly lower than that in occasional cholangitis (< 0.01). Compared with the EBD-poor group, the NLS rate in the EBD-good group of infants was significantly increased (< 0.001). EBD was significantly correlated with the occurrence and frequency of cholangitis (< 0.05).
Recurrent cholangitis was an important factor affecting NLS. For children without cholangitis after KPE, early bile drainage was better, and the NLS was longer.
探讨Kasai肝门空肠吻合术（KPE）后无胆管炎患儿的预后及相关因素。
回顾性分析2016年6月至2021年12月接受KPE的III型胆管闭锁婴儿的数据。比较并分析不同类型胆管炎患儿自体肝存活率（NLS）的差异。我们还研究了无胆管炎与早期胆汁引流（EBD）效果之间的关系以及影响EBD疗效的相关因素。
本研究共纳入145例患儿。其中，82例（56.6%，82/145）发生胆管炎，包括40例（48.8%，40/82）早期胆管炎和33例（40.2%，33/82）复发性胆管炎。中位随访期为29个月（范围2 - 75个月）。KPE后6个月、1年、2年和5年的NLS率分别为67.6%、51.7%、45.5%和43.4%，而KPE后无胆管炎婴儿的NLS率分别为68.3%、50.8%、46.0%和46.0%。KPE前较高的γ-谷氨酰转移酶（γ-GT）和总胆汁酸（TBA）是胆管炎的危险因素（<0.05）。复发性胆管炎的NLS率显著低于偶发性胆管炎（<0.01）。与EBD不良组相比，EBD良好组婴儿的NLS率显著提高（<0.001）。EBD与胆管炎的发生及频率显著相关（<0.05）。
复发性胆管炎是影响NLS的重要因素。对于KPE后无胆管炎的患儿，早期胆汁引流效果较好，自体肝存活时间更长。
