Xie Chuanping, Wang Peize, Wang Dingding, Jin Yuyan, Li Shuangshuang, Zhao Yong, Liao Junmin, Zhang Yanan, Hua Kaiyun, Gu Yichao, Du Jingbin, Chen Yongwei, Sun Dayan, Zhang Guojun, Huang Jinshi
Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
Department of Functional Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
BMC Pediatr. 2025 Jun 5;25(1):454. doi: 10.1186/s12887-025-05780-9.
BACKGROUND/PURPOSE: This study aimed to evaluate discrepancies in prognosis after the Kasai portoenterostomy (KPE) procedure between neonatal and non-neonatal periods among patients undergoing the KPE procedure less than 60 days after birth (≤ 60 days).
All type III BA patients who performed KPE less than 60 days from June 2020 to May 2024 in the Department of Neonatal Surgery of Beijing Children's Hospital were retrospectively reviewed. They were divided into two groups according to the age at Kasai: the early KPE group (EK group, or neonatal group ≤ 30 days after birth) and the late KPE group (LK group, or non-neonatal group 31-60 days after birth), to evaluate the effect of surgical age on the postoperative efficacy following Kasai.
61 BA patients were included in our study. The median age at KPE in the EK group was 14.0 [10.0, 20.0] days and 47.0 [36.8, 51.1] days in the LK group. Regarding postoperative complications, Patients in the EK group tended to have a higher incidence of postoperative intestinal obstruction (10.5% vs. 0.0%, p = 0.033) compared to those in the LK group. However, the postoperative long-term prognosis of KPE in the EK group seemed much better than in the LK group. Compared to the LK group, a significantly greater proportion of patients in the EK group achieved successful jaundice clearance (84.2% vs. 40.5%, p = 0.002) and successful bile acids clearance (63.2% vs. 19.0%, p = 0.001). Additionally, the one-year NLS in the EK group was also higher than the LK group despite without statistically significant difference (88.2% vs. 61.5%, p = 0.046). Kaplan-Meier curve also showed a significant difference between the two groups (p = 0.049, HR = 3.91, 95%Cl 1.46-10.46). Further, we evaluate the changes in biochemical indexes and liver hardness indicators over time in BA patients who had achieved one-year NLS. We found that compared to BA patients in the LK group, those in the EK group exhibited faster jaundice clearance and bile acids clearance, and more normalized biochemical indicators and liver hardness one year after Kasai.
Performing KPE procedure in the neonatal period was associated with a better long-term prognosis despite of potential increased risk of postoperative adhesive ileus.
背景/目的：本研究旨在评估出生后60天内（≤60天）接受肝门空肠吻合术（KPE）的患者在新生儿期和非新生儿期接受KPE手术后预后的差异。
回顾性分析2020年6月至2024年5月在北京儿童医院新生儿外科出生后60天内接受KPE手术的所有III型胆道闭锁（BA）患者。根据肝门空肠吻合术时的年龄将他们分为两组：早期KPE组（EK组，即出生后≤30天的新生儿组）和晚期KPE组（LK组，即出生后31 - 60天的非新生儿组），以评估手术年龄对肝门空肠吻合术后疗效的影响。
本研究纳入了61例BA患者。EK组肝门空肠吻合术时的中位年龄为14.0[10.0, 20.0]天，LK组为47.0[36.8, 51.1]天。关于术后并发症，与LK组相比，EK组患者术后肠梗阻的发生率更高（10.5%对0.0%，p = 0.033）。然而，EK组KPE术后的长期预后似乎比LK组好得多。与LK组相比，EK组中有显著更高比例的患者实现了黄疸清除成功（84.2%对40.5%，p = 0.002）和胆汁酸清除成功（63.2%对19.0%，p = 0.001）。此外，尽管无统计学显著差异，但EK组的一年无肝移植生存率也高于LK组（88.2%对61.5%，p = 0.046）。Kaplan - Meier曲线也显示两组之间存在显著差异（p = 0.049，HR = 3.91，95%Cl 1.46 - 10.46）。此外，我们评估了达到一年无肝移植生存率的BA患者生化指标和肝脏硬度指标随时间的变化。我们发现，与LK组的BA患者相比，EK组的患者在肝门空肠吻合术后一年黄疸清除和胆汁酸清除更快，生化指标和肝脏硬度更趋于正常。
尽管术后粘连性肠梗阻的风险可能增加，但在新生儿期进行肝门空肠吻合术与更好的长期预后相关。
