儿童DCD供肝肝移植术后胆道并发症高危因素研究

目的 分析儿童心脏死亡器官捐献(DCD)肝移植受者术后胆道并发症发生的高危因素.方法 收集天津市第一中心医院2013年3月至2015年3月施行的48例儿童DCD肝移植手术的临床资料,回顾性分析临床因素对受者胆道并发症的影响.结果 48例儿童DCD肝移植受者术后共11例发生胆道并发症,发生率为22.9％.单因素分析显示胆道并发症组与对照组间的热缺血时间(P=0.003)差异有统计学意义(P＜0.05),受体年龄(P--0.998)、受体性别(P=0.094)、MELD评分(P=0.159)、PELD评分(P=0.740)、Child-Pugh评分(P=0.159)、冷缺血时间(P=0.990)、受体ICU逗留时间(P=0.105)、是否发生感染(P=0.930)、有无其他并发症(门静脉狭窄/血栓形成、肝动脉栓塞、DGF)(P=0.268)以及A3O血型是否相容(P=1.106)差异无统计学意义(P＞0.05).多因素分析显示热缺血时间(P=0.020,OR=10.367,95％可信区间为1.451～74.089)是术后胆道并发症的独立危险因素.结论 胆道并发症仍然是儿童DCD肝移植术后的重要难题,热缺血时间是受者术后胆道并发症的独立危险因素.因此选择更短热缺血时间的CDC供肝可以降低儿童肝移植受者胆道并发症的发生率.     

移植物与受体质量比对婴儿活体肝移植术后门静脉流速的影响

目的 通过多普勒超声技术对婴儿活体肝移植术后早期没有严重并发症的受体门静脉流速进行测量,确定其术后早期门静脉流速的范围,并分析探讨影响门静脉流速的因素.方法 回顾分析于2008年4月至2009年12月间实施成功的成人活体供肝婴儿肝移植患儿22例(男14例,女8例,平均年龄为(6.8±2.5)个月,范围为80d至12个月.在术后第一个三天内,运用彩色多普勒超声仪检测受体术后门静脉流速及门静脉管径.通过Pearson's相关性检验分析受体年龄、受体门静脉管径、受体体重、移植物质量、移植物与受体质量比和受体术后门静脉流速的相关性.以多元回归分析确定独立因素与受体门静脉流速的关联性.结果 术后第一个三天受体门静脉流速的平均值是(36±15)cm/s(范围为17～73 cm/s).统计分析发现移植物与受体质量比和受体术后门静脉流速存在负相关(r=-0.591,P=0.005).多元回归分析显示移植物与受体质量比独立地与受体门静脉流速呈负相关(β=-10.483,P=0.005).结论 婴儿活体肝移植术后早期,移植物与受体质量比值影响着受体术后门静脉流速,并且受体门静脉血流速在术后早期有一宽量程.     

儿童肝移植20例诊治分析

目的回顾性分析20例肝移植患儿的临床资料,旨在总结儿童肝移植的临床诊治经验。方法回顾性分析2017年5月至2019年6月湖南省儿童医院联合中南大学湘雅附二医院对20例儿童实施肝脏移植手术的临床资料,原发疾病主要包括胆道闭锁、Alagille综合征、先天性肝内门静脉海绵样变性。手术方式采用亲体部分肝移植手术(n=16)和儿童心脏死亡器官捐献(donation after cardiac death,DCD)肝脏移植手术(n=4)。20例均应用他克莫司联合激素免疫抑制方案,其中3例增加了吗替麦考酚酯联合抗排斥反应。术后患儿给予抗感染、抗排斥等对症支持治疗,密切监测肝血管吻合处血流情况及肝功能变化,观察术后并发症及预后。结果 20例患儿均移植成功,肝移植供体均康复出院,无并发症发生。受体术后早期主要并发症为感染,以细菌感染为主,感染部位为肺部和腹腔。术后1例出现肝动脉栓塞,3例出现乳糜漏,2例出现胆道狭窄,3例出现早期排斥反应,1例出现消化道大出血,经对症治疗均痊愈出院,检测肝功能及血药浓度均在正常范围。结论儿童终末期肝病可通过活体肝移植或DCD肝移植手术取得理想的效果,手术方式可根据患儿的年龄、体重进行选择。     

儿童器官捐献婴儿肝移植术后早期肝动脉侧支循环的临床研究

目的 总结儿童器官捐献婴儿肝移植术后早期肝动脉侧支循环形成的临床特点,初步探讨发生该现象的潜在因素.方法 回顾性分析我院2013年12月至2015年12月的儿童器官捐献婴儿肝移植共49例,15例术后早期发生移植肝动脉闭塞,其中2例术后1周内死亡的受者被剔除出本研究,搜集其余13例受者的所有临床资料,分析该组病例术后的临床过程及预后.结果 儿童器官捐献婴儿肝移植术后早期肝内动脉分支闭塞9例,肝动脉主干闭塞4例,闭塞发生时间为术后(4.7±1.8)d.肝动脉分支闭塞组的9例患儿于闭塞发生后(9.7±5.3)d肝内动脉血流恢复;肝动脉主干闭塞组的4例患儿于闭塞发生后的(9.8±3.2)d出现肝内动脉侧支循环,于闭塞发生后的(20.0±5.0)d出现肝门部的动脉侧支循环.随访结果,有4例患儿术后发生胆道并发症,每组各2例,肝动脉主干闭塞组的1例行二次肝移植,余3例接受经皮肝穿刺胆道引流及球囊扩张治疗,移植肝功能基本正常.结论 肝动脉分支闭塞是儿童器官捐献婴儿肝移植术后早期肝动脉闭塞的主要类型.发生肝动脉主干闭塞的患儿均能在短期内建立代偿性侧支循环,对于远期可能发生的胆道并发症注意密切监测,及时治疗,长期临床预后有待进一步观察.     

儿童肝移植术后供体生活质量分析

目的 调查儿童活体肝移植术后供体的生活质量情况并探讨影响其生活质量的主要因素.方法 采用简明健康调查问卷(SF-36),对2005年1月至2014年12月在四川大学华西医院和重庆医科大学附属儿童医院实施的86例儿童活体肝移植供体进行了生活质量调查.所有纳入供体为不带肝中静脉的左半肝或左外叶切除者,且无重大并发症,能够较好应用汉语沟通者.将调查结果与普通人群生活质量进行比较,并对可能影响生活质量的因素进行分析探讨.结果 共发放符合调查要求的问卷80例,有效回收问卷71例(88.7％).男24例,女47例,平均年龄(29.4±8.0)岁.胆道闭锁患儿供体35例,代谢性肝病患儿供体15例,原发性肝硬化患儿供体11例,肝肿瘤及其他疾病患儿供体10例.移植供体主要为受体父母.总体上,肝移植供体术后生活质量水平在各维度与普通人群没有明显的差异(P＞0.05);胆道闭锁患儿供体在精神健康维度得分优于非胆道闭锁患儿供体(P=0.029);全自费医疗患儿供体在总体健康方面得分明显低于具有医疗保险患儿的供体(P=0.033);供体手术2年后在生理功能(P=0.038)及躯体疼痛(P=0.040)维度得分较术后2年内明显增高;应用主成分分析将生活质量8个维度综合为1个维度,结果提示术后时间是影响肝移植供体术后生活质量的首要因素(P=0.037).结论 儿童肝移植供体术后生活质量状况良好,术后时间、受体原发病和受体医疗形式是影响供体生活质量的主要因素.     

外周血嗜酸性粒细胞百分比对不同年龄段儿童肝移植术后早期急性排斥反应的预测价值CSCD

目的分析外周血嗜酸性粒细胞百分比与不同年龄儿童肝移植术后发生早期急性排斥反应的相关性,评估外周血嗜酸性粒细胞百分比对儿童肝移植术后早期排斥反应的预测价值。方法回顾性分析天津市第一中心医院2019年1月至2020年12月396例肝移植患儿的临床资料,患儿年龄分布:0~1岁282例(0~1岁组),1~6岁92例(1~6岁组),>6岁22例(>6岁组)。根据6个月内肝穿刺活检病理结果分为急性排斥组(n=71)和非排斥组(n=325)。比较不同年龄急性排斥组和非排斥组患儿术后早期外周血嗜酸性粒细胞百分比均值的差异,绘制轮廓图并对两组连续测量的嗜酸性粒细胞百分比进行重复测量方差分析,以确定术后早期外周血嗜酸性粒细胞百分比与发生急性排斥反应之间的相关性。运用ROC曲线确定急性排斥反应发生的早期嗜酸性粒细胞百分比的临界值。结果术后早期急性排斥反应发生率为17.93%(71/396)。在0~1岁儿童肝移植受者中,术后早期嗜酸性粒细胞百分比均值与急性排斥反应的发生显著相关(P<0.05),而其他年龄段的儿童肝移植受者术后早期嗜酸性粒细胞百分比均值与急性排斥反应的发生不存在相关性(P>0.05);术后1~7 d急性排斥组的嗜酸性粒细胞百分比的连续变化值显著高于非排斥组(F=25.380,P<0.001);在0~1岁儿童肝移植受者中,嗜酸性粒细胞百分比均值与急性排斥反应发生的ROC曲线显示,其曲线下面积为0.743(95%CI:0.668~0.817),灵敏度为63%,特异度为73%,临界值为3.23%,阳性预测值为31.18%(29/93),阴性预测值为91.05%(173/190)。结论在接受肝移植的儿童受者中,术后早期外周血嗜酸性粒细胞百分比均值对于0~1岁儿童肝移植后急性排斥反应的发生具有一定的预测价值,其特异度和阴性预测值较高,可作为早期风险筛查指标。     

胆道闭锁肝移植术后早期肝动脉血栓的诊断及处理

目的探讨胆道闭锁肝移植术后早期肝动脉血栓(hepatic arterythrombosis,HAT)的诊断、治疗以及对预后的影响。方法回顾性分析本院2006年6月至2014年4月间完成的41例胆道闭锁肝移植手术临床资料,术后早期常规监测血生化指标、彩色多普勒超声监测肝动脉血流,对疑有肝动脉血栓形成患者,行肝动脉造影或开腹肝动脉探查。结果术后9例发生早期肝动脉血栓,发生率21.95%,经肝动脉介入溶栓、肝动脉切开取栓或再次肝移植,2例死于肝动脉血栓,7例肝动脉再通,但围手术期2例死于肺部肺炎克雷白杆菌感染,1例死于肠漏后感染性休克,1例死于毛细血管渗漏综合征,1例再次肝移植者因原发肝无功能而死亡。结论胆道闭锁肝移植术后早期肝动脉血栓发生率较高,也是导致死亡的重要原因之一,对于可疑HAT者,尽早行肝动脉造影确诊及溶栓治疗、开腹探查肝动脉切开取栓治疗可有效诊断和治疗HAT。     

胆道闭锁患儿亲体肝移植术后急性肺损伤风险因素分析

目的 分析胆道闭锁患儿亲体肝移植术后急性肺损伤的风险因素.方法 收集天津市第一中心医院2012年5月至2016年3月实施的112例胆道闭锁患儿亲体肝移植术临床资料,回顾性分析临床因素对患儿术后急性肺损伤的影响.结果 112例胆道闭锁患儿亲体肝移植患儿术后23例发生急性肺损伤,发生率为20.5％.单因素logistic回归分析显示肺部并发症组与对照组间年龄(P=0.010)、术前白蛋白(P=0.012)、术前总胆红素(P=0.001)、术前血清肌酐(P＜0.001)、术后1周内总胆红素峰值(P=0.035)差异有统计学意义(P＜0.05).多因素logistic回归分析显示,术前白蛋白(P=0.010,OR=0.830,可信区间为0.720～0.957)、术前总胆红素(P=0.001,OR=1.010,可信区间为1.004～1.016)及术前血清肌酐(P=0.001,OR=1.237,可信区间为1.104～1.387)是术后急性肺损伤发生的高危因素.结论 急性肺损伤是胆道闭锁患儿亲体肝移植术后的严重并发症,术前血清白蛋白、总胆红素及肌酐水平是患儿急性肺损伤发生的高危风险因素.     

活体肝移植治疗胆道闭锁:22例单中心诊治经验

目的 总结活体肝移植治疗儿童终末期肝病胆道闭锁(BA)的外科治疗经验.方法 2006年6月至2009年7月,共完成亲属活体部分肝移植治疗胆道闭锁22例.术后平均随访18.5(1至36个月)个月,回顾总结肝移植患儿临床病理资料.结果 22例胆道闭锁患儿中已行Kasai手术9例,20例低于1岁,21例低于10kg.其手术平均时间、平均出血均无差别.供肝受体质量(GR/WR)比3.5(2.1～5.7)%.有27例次术后并发症,包括3例术后出血再手术止血,1例门静脉并发症,肝静脉并发症1例,3例肝动脉并发症,胆道并发症1例.有3例围手术死亡,1例再次移植,急性排斥5例(22.7%).6个月、1年和3年受体生存率分别为86.4%、82.2%和82.2%.结论 受体体重,移植物受体质量比,是否行Kasai手术对肝移植手术效果无影响;适当的供肝质量,细致的手术技巧可增加手术成功率.     

活体肝移植治疗胆道闭锁:22例单中心诊治经验

目的 总结活体肝移植治疗儿童终末期肝病胆道闭锁(BA)的外科治疗经验.方法 2006年6月至2009年7月,共完成亲属活体部分肝移植治疗胆道闭锁22例.术后平均随访18.5(1至36个月)个月,回顾总结肝移植患儿临床病理资料.结果 22例胆道闭锁患儿中已行Kasai手术9例,20例低于1岁,21例低于10kg.其手术平均时间、平均出血均无差别.供肝受体质量(GR/WR)比3.5(2.1～5.7)%.有27例次术后并发症,包括3例术后出血再手术止血,1例门静脉并发症,肝静脉并发症1例,3例肝动脉并发症,胆道并发症1例.有3例围手术死亡,1例再次移植,急性排斥5例(22.7%).6个月、1年和3年受体生存率分别为86.4%、82.2%和82.2%.结论 受体体重,移植物受体质量比,是否行Kasai手术对肝移植手术效果无影响;适当的供肝质量,细致的手术技巧可增加手术成功率.     

Hepatic artery thrombosis in pediatric liver transplantation: Graft salvage after thrombectomy

Hepatic artery thrombosis (HAT) is a devastating complication that may occur after orthotopic liver transplantation (OLT). A higher incidence has been reported in children. Salvage of the graft by thrombectomy has been suggested as an alternative to re-transplantation. In this study we report the outcome of three children who underwent thrombectomy for HAT. Between January 1992 and June 1998, 14 children (< 17 yrs of age) underwent liver transplantation. Three developed HAT (one a whole-liver graft recipient, age 17; two living-related graft recipients, ages 4 and 4.5 yr). In the first patient, thrombosis of the hepatic artery was associated with scattered areas of parenchymal necrosis on computed tomography. In the two living-related patients, HAT was found incidentally during re-exploration for bleeding (day 2 and day 10). Thrombectomy was performed in all three patients. At 18-24 months after thrombectomy, all three children had normal graft function. In the first patient, complete regeneration of the liver has been documented by computed tomography and a late asymptomatic recurrent thrombosis is suggested by absence of arterial flow on Doppler examination. The hepatic artery is patent in the two living-related recipients. One of these living-related recipients developed ischemic bile duct stricture and underwent successful percutaneous balloon dilatation. We conclude that long-term normal graft function can be achieved by thrombectomy in pediatric liver recipients with HAT, even in the presence of limited parenchymal damage.     

Donor‐to‐recipient weight ratio is a risk factor for hepatic artery thrombosis after whole‐liver transplantation in children under 25 kg

Hepatic artery thrombosis (HAT) following pediatric liver transplantation increases morbidity and risk of graft failure. We performed a retrospective chart review of all patients who underwent deceased‐donor liver transplantation from August 2002 to July 2016. Multi‐organ transplant recipients were excluded. We examined the incidence of HAT at our institution and sought to identify associated donor or recipient risk factors. A total of 127 deceased‐donor liver transplant patients with a median age of 1.7 years (IQR 0.67‐6.7) were identified. Of those, 14 developed HAT, all weighing under 25 kg. Among 100 patients under 25 kg, whole‐liver graft recipients had an odds ratio of 3.98 (95% confidence interval [CI]: 1.03, 15.34; P = .045) for developing HAT compared with split‐liver graft recipients. Within the whole‐liver recipient group under 25 kg, 11 patients developed HAT with a median donor‐to‐recipient ratio (DRWR) of 0.9 (IQR: 0.7‐1.2) compared with a median DRWR of 1.4 (IQR: 1.1‐1.9) for those who did not develop HAT. Multivariate analysis showed DRWR to be an independent risk factor for HAT in patients weighing under 25 kg who received whole organ grafts, with an odds ratio of 3.89 (95% CI: 1.43, 10.54; P = .008) for each 0.5 unit decrease in DRWR. Our results suggest that in recipients under 25 kg 1) split‐liver grafts may have a lower rate of HAT and 2) selecting whole organ donors with a higher DRWR may decrease the incidence of HAT.     

A single center experience of donation after cardiac death liver transplantation in pediatric recipients

Bartlett A, Vara R, Muiesan P, Mariott P, Dhawan A, Mieli‐Vergani G, Rela M, Heaton N. A single center experience of donation after cardiac death liver transplantation in pediatric recipients.
Pediatr Transplantation 2010:14: 388–392. © 2009 John Wiley & Sons A/S. Abstract: Many centers are now performing DCD adult LT. There has been a reluctance to transplant pediatric recipients with DCD livers due to concern over the medium to long‐term outcome. We describe the outcome of 14 children (median age seven yr, 8 months–16 yr) that underwent LT with DCD grafts from July 2001 to December 2007. Donors had a median age of 23 yr (10–64), intensive care stay of five d (2–14) and bilirubin of 9 mmol/L (6–60). Median warm and cold ischemic time was 16 min (11–29) and seven h (5.5–8.4). Livers were transplanted as a whole organ (4), reduced graft (8), formal split (1) or auxiliary transplant (1). Compared to DBD recipients AST was significantly higher on the first three post‐operative days and there was no difference in the INR, bilirubin or GGT out to 12 months. There were no biliary or vascular complications and patient and graft survival is 100% at a median follow‐up of 41.8 months (1.7–74 months). LT with DCD grafts in pediatric recipients can be performed with low morbidity and excellent short‐to‐medium term patient and graft outcome.     

First report of successful transplantation of a pediatric donor liver graft after hypothermic machine perfusion

One of the main limiting factors in pediatric liver transplantation is donor availability. For adults, DCD liver grafts are increasingly used to expand the donor pool. To improve outcome after DCD liver transplantation, ex situ machine perfusion is used as an alternative organ preservation strategy, with the supplemental value of providing oxygen to the graft during preservation. We here report the first successful transplantation of a pediatric DCD liver graft after hypothermic oxygenated machine perfusion. The full‐size liver graft was derived from a 13‐year‐old, female DCD donor and was end‐ischemic pretreated with dual hypothermic oxygenated machine perfusion. Arterial and portal pressures were set at 18 and 4 mm Hg, slightly lower than protocolized settings for adult livers . During 2 hours of machine perfusion, portal and arterial flows increased from 100 to 210 mL/min and 30 to 63 mL/min, respectively. The pretreated liver graft was implanted in a 16‐year‐old girl with progressive familial intrahepatic cholestasis type 2. Postoperative AST, ALT, and prothrombin time normalized within a week. The recipient quickly recovered and was discharged from the hospital after 18 days. One year after transplantation, she is in excellent condition with a completely normal liver function and histology. This case is the first report of successful transplantation of a pediatric DCD liver graft after hypothermic oxygenated machine perfusion and illustrates the potential role of ex situ machine perfusion in expanding the donor pool and improving outcome after pediatric liver transplantation.     

腹腔镜小儿斜疝疝囊高位结扎术后疝复发相关因素分析

目的 探讨影响腹腔镜小儿斜疝疝囊高位结扎术术后疝复发的因素.方法 回顾性分析2008年1月至2014年12月南充市中心医院收治的行腹腔镜下疝囊高位结扎术的儿童患儿临床资料264例.用Logistic回归模型对腹腔镜下小儿疝囊高位结扎术术后复发的相关因素进行单因素和多因素分析.共有年龄、性别、BMI、疝部位、术前病程、术前是否嵌顿、疝环口大小、结扎线种类等8个因素纳入分析.应用ROC曲线评估术后疝复发的风险,并做风险等级划分.结果 264例患儿共完成346侧手术,患儿最小年龄3个月,最大年龄13岁,平均年龄为(3.3±2.9)岁.其中男229例,女35例.共有39例术前曾发生疝嵌顿,发生于右侧腹股沟者有114例,发生于左侧者有68例,发生于双侧者有82例.其中有11例疝于术后1个月至2年出现复发,复发率为3.2％.术后复发的11例患儿中,年龄最小者为4岁,小于4岁的患儿无一例术后出现复发.单因素分析和多因素分析均显示年龄、内环口大小、结扎线是影响患儿术后是否出现疝复发的独立危险因素.不同风险等级的患儿术后复发的发生率差异有统计学意义(x2=31.434,P＜o.05).结论 腹腔镜下疝囊高位结扎尽量避免使用可吸收线,对于复发高风险患儿可选择一些改良的腹腔镜手术.     

Frequency of and factors associated with vascular complications after pediatric liver transplantation

Objectiveto evaluate the frequency and factors associated with vascular complications after pediatric liver transplantation.Methodrisk factors were evaluated in 99 patients under 18 years of age with chronic liver disease who underwent deceased donor liver transplantation (DDLT) between March of 1995 and November of 2009 at the Hospital de Clínicas de Porto Alegre, Brazil. The variables analyzed included donor and recipient age, gender, and weight; indication for transplant; PELD/MELD scores; technical aspects; postoperative vascular complications; and survival.Resultsvascular complications occurred in 19 patients (19%). Arterial events were most common, occurred earlier in the postoperative period, and were associated with high graft loss and mortality rates. In the multivariate analysis, the following factors were identified: portal vein diameter ≤ 3 mm, donor‐to‐recipient body weight ratio (DRWR), prolonged ischemic time, and use of arterial grafts.Conclusionthe choice of treatment depends on the timing of diagnosis; however, in this study, surgical revision or correction produced worse outcomes than percutaneous angioplasty. The reduction of risk factors and early detection of vascular complications are key elements to a successful transplantation.     

Low incidence of hepatic artery thrombosis after pediatric liver transplantation without the use of intraoperative microscope or parenteral anticoagulation

The risk of hepatic artery thrombosis (HAT) after pediatric liver transplantation (PLT) has been reported to range from 0 to 25%. We report our experience focusing on the interrelationships between risk factors, surgical technique and the incidence of HAT after liver transplantation in the pediatric age group. From February 18, 1997 to December 31, 2003, 150 consecutive liver transplants were performed in 132 pediatric patients. There were similar numbers of whole grafts when compared with partial grafts, 80 (53.3%) vs. 70 (46.7%), p = 0.30. Four grafts (2.7%) developed HAT. Of the grafts with HAT, three were successfully revascularized within the first 24 h. Only one graft (0.66%) was lost to HAT. A single surgeon utilizing 3.5-6.0 magnification loupes performed all but one hepatic arterial anastomoses. All patients were followed postoperatively by a daily ultrasound protocol and with anticoagulation of aspirin and alprostadil only. Living and deceased donor left lateral segment grafts had an increased rate of HAT when compared with whole liver grafts. HAT with subsequent graft loss may be minimized in PLT with the use of surgical loupes only, anticoagulation utilizing aspirin, alprostadil, and daily ultrasounds.     

胆道闭锁Kasai术后相关预后因素分析和对策

目的 探讨影响胆道闭锁(biliary atresia,BA) Kasai术后预后的相关因素,了解我省BA的治疗现状.方法 回顾性分析2009年1月至2015年12月间,在山西省儿童医院行腹腔镜探查、胆道造影确诊胆道闭锁后行Kasai术且随访资料完整的91例患儿.采用Kaplan-Meier法计算各亚组患儿自体肝存活率.各亚组之间自体肝存活率的比较应用Log-rank检验,多因素分析采用COX回归模型.结果 全组患儿6个月、1年、2年的自体肝存活率分别为76.9％(70/91)、48.3％(44/91)、36.3％(33/91).按手术日龄将患儿分为:＜60 d(34例)、60～90(含60)d(47例)、90～120(含90)d(8例)和≥120 d(2例)组,各组2年累计自体肝存活率分别为55.8％(19/34)、44.7％(21/47)、12.5％(1/8)和0(P=0.047).男、女童2年累计自体肝存活率分别为36.4％(16/44)和46.8％(22/47),差异无统计学意义(P=0.313).有胆管炎发作组(67例)与无胆管炎发作组(24例)的2年累计自体肝存活率分别为31.3％(21/67)和62.5％(15/24)(P=0.011);黄疸消退明显组(61例)和黄疸消退不明显组(30例)的2年累计自体肝存活率分别为50.8％(31/61)和23.3％ (7/30) (P=0.012);肝功能恢复良好组(53例)和肝功能恢复较差组(38例)2年累计自体肝存活率分别为56.6％(30/53)和21.1％(8/38)(P=0.01);Ⅰ型、Ⅱ型、Ⅲ型闭锁的2年累计自体肝存活率分别为77.8％(7/9)、66.7％(4/6)和31.6％(24/76)(P=0.023),差异均有统计学意义.结论 手术日龄、有无胆管炎发作、黄疸消退情况、肝功能恢复情况及胆道闭锁分型为影响Kasai手术预后的影响因素,其中手术日龄、黄疸消退和肝功能恢复情况是影响生存的独立预后因素.提高民众对胆道闭锁的认知水平,加强术后随访评估,对提高胆道闭锁生存率有重要意义.