胆道闭锁术后早期胆管炎风险因素分析

目的 探讨影响胆道闭锁术后早期胆管炎发作的风险因素. 方法 对本院2007年1月至2011年12月收治胆道闭锁患儿临床资料进行回顾性分析.所有患儿均采用统一治疗方案,包括手术方式为标准Kasai手术或肝管空肠吻合术,术中胆支引流肠襻45 cm,术后使用激素、抗菌素和利胆药物.将病例以手术年龄、术后黄疸清除效果、Ohi分型和肝纤维化病理分级进行分组,分析影响早期胆管炎发作的原因. 结果 共有139例BA患儿进行手术,124例获得随访.术后35例早期胆管炎发作,发生率为28.3％.术后黄疸完全清除率早期胆管炎发作组低于未发作组（28.2％∶71.8％,P=0.004）,术后1年、2年自体肝生存率早期胆管炎发作组低于未发作组（分别为44.5％±8.5％∶86.5％±3.6％,44.5％±8.5％∶76.3％±4.5％,P=0.003）.Logistic分析显示黄疸清除速度（P=0.000）,肝纤维化病理分级（P =0.029）和Ohi分型基本型（P =0.042）影响早期胆管炎发作而与手术年龄（P=0.579）,Ohi分型亚型（P=0.511）和肝外胆管详细分型（P =0.224）无关.结论 良好的肝门部病变类型,术后较好的胆汁引流和较轻的肝纤维化有利于减少胆道闭锁术后早期胆管炎的发生.

Risk Factors of Postoperative Early Cholangitis in Biliary Atresia

Objetive To explore the risk factors of early postoperative cholangitis occurring in children＇s biliary atresia（BA）.Methods From January 2007 to December 2011,clinical data of BA in our unit were retrospectively analyzed.All the cases were used with the same protocol including surgery in standard Kasai procedure or hepaticoenterostomy with 45cm＇s length of Roue-loop,postoperative use of steroid,antibiotics and choleretic drugs.The cases were divided into groups according to age at surgery,the evaluation of postoperative biliary drainage,liver fibrosis and Ohi type （basic type,subtype and bile duct with detail type）.Results There were 139 cases of BA with surgery and 124 cases had a completely follow-up.There were 35 cases with onset of early cholangitis,the onset rate was 28.3％.Compared with the cases without onset of early cholangitis,cases with onset have lower ratio of jaundice free of post-operation （28.2％ vs 71.8％,P =0.004） and lower 1,2 year＇s survival rate with native liver （44.5 ± 8.5％ vs 86.5-± 3.6％,44.5 vs 8.5％ vs 76.3 ± 4.5％,respectively,P =0.003）.The logistic regression showed the evaluation of biliary drainage （P =0.000）,liver fibrosis （P =0.029） and Ohi basic type （P =0.042） not age at surgery （P =0.579）,Ohi subtype （P =0.511） and detailed type of bile duct （P =0.25） were correlated to the onset of early cholangitis.Conclusion In BA,better type of anatomic pattern and biliary drainage after surgery,slighter liver fibrosis help to reduce the risk of early cholangitis occurred.