矩形瓣在Kasai手术治疗Ⅲ型胆道闭锁近中期预后的回顾性研究

摘要

Objetive To explore the effect of the rectangular flap anti-reflux valve on the early and mediumterm outcomes in the treatment of type Ⅲ biliary atresia with Kasai operation.Methods From Jan.2013 to Jan.2017,63 children with type Ⅲ biliary atresia were operated in our unit.Accroding to the surgical procedures,they were grouped into RF(-) group and RF(+) group.This study was aimed to analyze early and medium-term liver function recovery by comparing the ALT and Tbil,and analyze early and mediumterm native liver survival rates by Kaplam-Meier analysis.Results For 63 BA children,33 patients were under single Roux-en-Y hepaticojejunostomy,and 30 patients were under rectangle flap lying on the jejunal segmental of Roux-en-Y hepaticojejunostomy.There were no significant differences of patients,gender,age,liver function before surgery.No statistical difference of postoperative liver function improvement in 12 months,18 months,24 months,30 months,36 months.The 12-month postoperative native liver survival rate was 72.7％ and 73.3％,respectively.The 18-month postoperative native liver survival rate was 66.7％ and 73.3％,respectively.The 24-month postoperative native liver survival rate was 60.6％ and 63.3％,respectively.The 30-month postoperative native liver survival rate was 57.6％ and 60.0％,respectively.The 36-month postoperative native liver survival rate was 48.5％ and 46.7％,respectively.Conclusion There was no significant difference in the prognosis of the patients in the near and middle stage in the treatment of type Ⅲ biliary atresia by Kasai operation.%目的 探究矩形瓣抗反流阀在Kasai手术治疗Ⅲ型胆道闭锁中对近中期预后的影响.方法 回顾性分析2013年1月-2017年1月在新疆医科大学第一附属医院行Kasai手术并获得随访的63例Ⅲ型胆道闭锁患儿,根据手术方式分为矩形瓣组(RF+组)和非矩形瓣组(RF-组).通过对术后12～36个月肝生化谷丙转氨酶(ALT)、总胆红素(TBil)中位数的秩和检验,比较2组Kasai术后中期肝功能情况(ALT、TBil);应用Kaplan-Meier生存分析比较两组近中期生存率差异.结果 63例Ⅲ型胆道闭锁患儿中,RF+组30例,RF-组33例;2组年龄分布、性别比例、术前肝功能(TBil、ALT)中位数等均无统计学差异.术后12个月、18个月、24个月、30个月、36个月2组肝功能(TBil、ALT)恢复情况无统计学差异.Kasai术后RF-组和RF+组的自体肝生存率:12个月生存率分别为72.7％和73.3％,18个月生存率分别为66.7％和73.3％,24个月生存率分别为60.6％和63.3％,30个月生存率分别为57.6％和60.0％,36个月生存率分别为48.5％和46.7％.结论 在Kasai手术治疗Ⅲ型胆道闭锁中设置矩形瓣抗反流阀与否对患儿近中期预后的影响无明显差异.