Gu Chunhui, Sun Jian, Ding Lihong, Li Bing, Jiang Guoqing, Zhang Youcheng
Department of Pediatric Surgery, Huai'an Maternal and Child Health Care Hospital Affiliated to Yangzhou University, Huai'an, China.
College of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China.
Front Pediatr. 2025 May 14;13:1541455. doi: 10.3389/fped.2025.1541455. eCollection 2025.
To evaluate the early efficacy and safety of partial quadrate lobectomy during laparoscopic Kasai surgery for type III biliary atresia.
This retrospective study included 25 children diagnosed with type III biliary atresia, who underwent laparoscopic Kasai surgery between February 2018 and July 2022. Patients were divided into two groups: one with partial quadrate lobectomy and the other without. Data collected included age, gender, weight, incidence of cholangitis before and after surgery, one-year native liver survival, intraoperative blood loss, surgery duration, and jaundice clearance at 6 and 12 months. Follow-up results were compared between the groups.
The partial quadrate lobectomy group (14 patients) had a mean weight of 5.50 kg and average age of 66.79 days, while the control group (11 patients) had a similar weight (5.50 kg) and a mean age of 71.09 days. Weight comparison showed no significant difference (5.50 kg vs. 5.50 kg, = 0.427). One-year postoperative native liver survival was 9/14 in the partial quadrate lobectomy group vs. 6/11 in the control group ( = 0.654).Intraoperative blood loss was similar between groups ( > 0.05), but the shorter operative time (301 vs. 347 min) associated with partial quadrate lobe resection may reduce anesthesia-related risks in infants, particularly given their limited physiological reserve. The reduced cholangitis rate (29% vs. 73%) aligns with prior reports suggesting that improved hilar exposure facilitates more precise dissection of fibrotic remnants, potentially minimizing postoperative bile stasis and infection. Jaundice clearance (defined as TBIL <20 μmol/L) was achieved in 8/14 (57.1%) of the partial quadrate lobectomy group vs. 3/11 (27.3%) in the control group at 6 months ( = 0.025), and 10/14 (71.4%) vs. 4/11 (36.4%) at 12 months ( = 0.031). The lower TBIL levels (5.11 vs. 9.67 mg/dl) at 6 months suggest enhanced bile drainage efficacy, which is critical for delaying or avoiding liver transplantation in this population.
Partial quadrate lobectomy during laparoscopic Kasai surgery reduces operation time, lowers cholangitis incidence, and improves jaundice clearance rates without increasing intraoperative blood loss or adversely affecting one-year native liver survival. It is a safe and feasible adjunct to improve early postoperative outcomes.
评估在腹腔镜下葛西手术中对Ⅲb型胆道闭锁患儿行部分肝方叶切除术的早期疗效及安全性。
本回顾性研究纳入了25例诊断为Ⅲb型胆道闭锁的患儿，这些患儿于2018年2月至2022年7月间接受了腹腔镜下葛西手术。将患者分为两组：一组行部分肝方叶切除术，另一组未行该手术。收集的数据包括年龄、性别、体重、手术前后胆管炎的发生率、1年自体肝生存率、术中出血量、手术时长以及术后6个月和12个月时黄疸清除情况。比较两组的随访结果。
部分肝方叶切除术组（14例患者）平均体重为5.50 kg，平均年龄为66.79天，而对照组（11例患者）体重相似（5.50 kg），平均年龄为71.09天。体重比较显示无显著差异（5.50 kg对5.50 kg，P = 0.427）。部分肝方叶切除术组术后1年自体肝生存率为9/14，对照组为6/11（P = 0.654）。两组术中出血量相似（P>0.05），但部分肝方叶切除术相关的手术时间较短（301对347分钟），这可能降低婴儿麻醉相关风险，特别是考虑到他们有限的生理储备。胆管炎发生率降低（29%对73%），这与之前的报道一致，即肝门暴露改善有助于更精确地解剖纤维化残留组织，可能将术后胆汁淤积和感染降至最低。部分肝方叶切除术组在术后6个月时8/14（57.1%）实现黄疸清除（定义为总胆红素<20 μmol/L），对照组为3/11（27.3%）（P = 0.025），术后12个月时分别为10/14（71.4%）和4/11（36.4%）（P = 0.031）。术后6个月时较低的总胆红素水平（5.11对9.67 mg/dl）表明胆汁引流效果增强，这对于延迟或避免该人群进行肝移植至关重要。
腹腔镜下葛西手术中进行部分肝方叶切除术可缩短手术时间，降低胆管炎发生率，提高黄疸清除率，且不增加术中出血量或对1年自体肝生存率产生不利影响。它是改善术后早期结局的一种安全可行的辅助手段。
