不同年龄胆道闭锁患儿手术效果分析

目的 分析胆道闭锁手术年龄与术后早期效果的关系以及较大年龄（＞90 d）患儿的Kasai手术指征.方法 2004-2010年复旦大学附属儿科医院收治胆道闭锁患儿452例,均经术中胆道造影确诊.手术采用标准的Kasai术,术后常规使用激素,对不同年龄组患儿术前肝功能、B超等资料及术后胆红素下降情况进行分析,总胆红素水平低于20 mmol/L定为黄疸完全消退.结果 将所有患儿根据年龄分为三组,手术年龄≤60 d者146例,手术年龄在60～90 d者222例,＞90 d者84例（90～10Od者33例,100～110 d 26例,110～120d 10例,120～ 130 d 8例,＞130 d 7例）.术前各年龄组总胆红素、直接胆红素、谷丙转氨酶无显著差异.术后2周,60 d以内组,胆红素下降水平最低（P＜0.05）,＜45 d患儿胆红素下降水平并未更加显著.术后3个月随访率为61.3％,各年龄组总胆红素水平无显著差异（F=0.132,P=0.970）.术后6个月随访率37.4％,90 d以上组总胆红素（58.09±58.55） mmol/L,90 d以内组总胆红素水平（27.67±30.60） mmol/L（P=0.226）.＞90d患儿,每间隔10d分成一组,各组间术后早期胆红素下降水平无差异（F=1.115,P=0.355）.＞90 d手术患儿两年自体肝生存率为36.1％.90 d以上患儿延误手术原因：39.2％因家长未重视,51.6％因误诊婴儿肝炎耽误治疗.结论 胆道闭锁患儿＞90 d并非手术绝对禁忌,多数患儿可取得较好的早期黄疸消退,部分患儿术后6个月可以有较好的肝功能恢复.

The influence of age at surgery in patients with biliary atresia in older infants

Objetive To analysis the relationship between age and the early surgical outcome of Kasai procedure for the older infant with biliary atresia（BA）.Methods All infants who had undergone surgery for BA during the period 2004 through 2010 were reviewed.During the study period,the definitive diagnosis was confirmed with operative cholangiogram and the details of liver function before and after the operation were reviewed.Results A total of 452 infants have type Ⅲ BA diagnosis during this period.All of the patients were divided into 3 groups according to their age at operation （group A：on or before 60 days （146 cases） ; group B：between 60 to 90 days （222 cases） ; group C：on or after 90 days （84 cases）.The total bilirubin level （TBIL）,direct bilirubin level （DBIL）,and alanine transaminase（ALT） level showed no difference between each group before the Kasai procedure.The worst outcome of clearance of jundice was found in group A,but not in group C two weeks postoperatively （P ＜ 0.05）.In the point of three months and six month postoperative,TBIL in each group showed no difference.In group C,two year survival rates of our patients with their native livers were 36.1％.Conclusion Perform the Kasai operation beyond the age of 90 days was not associated with a worse outcome.A part of patients could still achieve good bile flow with normal bilirubin postoperatively.