胆道闭锁Kasai术后早期行肝移植手术的危险因素分析

目的 探讨胆道闭锁（BA）Kasai术后自体肝生存时间的影响因素，从而得出早期行肝移植手术的危险因 素，为 BA治疗提供循证医学证据。方法 回顾性分析 167例胆道闭锁 Kasai术后因肝功能衰竭行肝移植手术的患儿 资料，根据 Kasai手术与肝移植手术的间隔时间将其分为 G1组（≤6个月）、G2组（＞6个月~2年）和 G3组（>2年），比较 3组患儿性别、Kasai手术年龄、Kasai术后黄疸消除、Kasai术后胆管炎发生及肝移植时肝功能指标情况，采用c2检验、 方差分析、Kruskal-Wallis H检验和多分类 Logistic回归分析查找自体肝生存时间的影响因素，即早期行肝移植手术 的影响因素。结果 3组间性别、Kasai手术年龄差异无统计学意义。3组间 Kasai术后黄疸消除率差异有统计学意 义（P＜0.01），G1组至 G3组逐渐升高；术后早期胆管炎发生率差异有统计学意义（P＜0.05），G3组低于 G1组；术后晚 期胆管炎发生率差异有统计学意义（P＜0.01），G2 组高于 G1 组；术后频发胆管炎发生率差异有统计学意义（P＜ 0.05），G3组低于 G2组。多分类 Logistic回归分析示黄疸未消除是胆道闭锁 Kasai术后自体肝生存的危险因素。结 论 胆道闭锁 Kasai术后黄疸未消除及早期胆管炎影响 Kasai术后自体肝生存时间，与早期行肝移植手术存在相关 性，其中黄疸未消除是早期行肝移植手术的危险因素。

Risk factors of early liver transplantation after Kasai procedure for biliary atresia

Objective To explore the influencing factors of the survival time of autologous liver after Kasai procedure for biliary atresia(BA), and to find out the risk factors of early liver transplantation, so as to provide data of evidence-based medicine for BA treatment. Methods Data of 167 BA children underwent liver transplantation due to hepatic failure after Kasai procedure were retrospectively analyzed. According to the operation interval between Kasai procedure and liver transplantation, they were divided into G1 (≤6 months), G2 (＞6 months - 2 years) and G3 (>2 years) groups. Data of patient gender, patient age of Kasai procedure, jaundice clearance, cholangitis after Kasai procedure and liver function indexes before liver transplantation were compared between three groups. The χ2 test, variance analysis, Kruskal-Wallis H test and multiple logistic regression analysis were used to find out the influencing factors for the survival time of autologous liver, that is, the influencing factors of early liver transplantation. Results There were no significant differences in gender and age of Kasai procedure between the three groups. There was statistical difference in the clearance of jaundice between the three groups (P＜0.01), showing a gradually increase from G1 to G3. There was significant difference in the early cholangitis between the three groups (P＜0.05), which was lower in G3 group than that of G1 group. There was significant difference in the late cholangitis after surgery between the three groups (P＜0.01), which was higher in G2 group than that of G1 group. There was statistical difference in the incidence of frequent cholangitis between the three groups (P＜0.05), which was lower in G3 group than that of G2 group. Multiple logistic regression analysis showed that persistent jaundice was the risk factor for native liver survival after Kasai procedure. Conclusion Persistent jaundice and early cholangitis after Kasai procedure can reduce the native liver survival time, which is related to the early liver transplantation. Persistent jaundice is a risk factor for early liver transplantation after Kasai procedure.