胆道闭锁Kasai术后生存2年以上病例临床分析

目的探讨胆道闭锁Kasai手术的治疗效果、判断标准和预后。方法对2009年3月至2010年3月在我院行Kasai手术后存活2年以上22例Gross分型III型胆道闭锁患儿的肝功能、胆管炎是否发作、B超肝纤维化评分、食道吞钡、病原学检查以及T细胞功能测定进行随访。结果22例均获得胆红素完全消退，黄疸完全消退时间为（4．64±1．33）周；17例转氨酶（ALT）正常，5例未降至正常；胆管炎发作2例，分别为术后2周和5周；5例出现超声肝纤维化评分增高；吞钡未出现食管静脉曲张病例；7例检出明确病毒抗体阳性；7例存在细胞免疫异常（CD8＋增高，CD4／CD8值下降）。肝功能、病原感染以及免疫机制与肝纤维化存在相关性（P〈0．05）。结论胆道闭锁Kasai术后获得良好的胆汁引流和胆红素的完全消退是决定生存的条件，黄疸术后约6周完全消退者预后较好。良好的胆汁引流和合理的术后预防用药可避免和减少胆管炎的发生。长期生存患儿仍有部分出现肝纤维化活动，与病毒感染活动和免疫机制异常有关。

Analysis of cases with Kasai portoenterostomy of survival more than 2 years

To explore the treatment criteria and prognosis of Kasai portoenterostomy.The clinical data of 22 cases of Gross typing type III biliary atresia the Kasai portoenterostomy postoperative children survived more than 2 years from Mar 2009 to Mar 2010 were analyzed.Liver function tests,Cholangitis whether the occur,liver fibrosis score with B ultrasound,esophageal barium swallow,etiological examination and determination of T cell function were index being used to in the postoperative clinical follow-up.Clearance of jaundice and serum bilirubin within normal range were in 22 cases,clearance of jaundice average time was(4.64 ± 1.33) weeks.17 cases of aminotransferase(ALT) normal,5 cases have not yet been.There are two cases of cholangitis occured,the shortest onset time after two weeks,up to five weeks after surgery.5 cases of ultrasound liver fibrosis score increased and barium swallow does not appear esophageal varices cases.7 cases were found the virus antibody-positive.7 cases of cellular immune abnormalities.There are correlation between Liver function,pathogen infection,immune mechanisms and liver fibrosis.The survive is decided by the clearance of jaundice and serum bilirubin within normal range in biliary atresia Kasai portoenterostomy.The cases with Clearance of jaundice and serum bilirubin within normal range within six weeks have the better prognosis.Good biliary drainage and postoperative prophylaxis can be avoided and reduce the occurrence of cholangitis.Liver fibrosis in children with long-term survival are still some activity,which might be relative to the viral infection and immune mechanism.