胆道闭锁术后反复发作性胆管炎抗感染治疗的中长期随访

目的探讨先天性胆道闭锁肝门空肠吻合术(Kasai术)后反复发作胆管炎患儿经抗感染治疗后自体肝存活情况及行肝移植术的时机。方法对本院2002年至2011年Kasai术后反复发作胆管炎患儿18例进行抗感染治疗,并对这部分患儿进行中长期随访,了解其自体肝存活情况。结果 2例分别在胆管炎病程4个月和5个月后行肝移植术,其余16例均坚持抗感染治疗。12例在抗感染治疗6~15个月后症状消失。随访5~12年10例仍自体肝存活,但均有肝硬化症状;其余2例因继发腹水或消化道出血予肝移植。另外4例治疗中出现肝内胆管扩张,行经皮肝穿刺置管引流(PTBD)。引流后1例放弃治疗死亡;2例引流后仍无法控制感染行肝脏移植手术后感染消退;1例行肝门部再吻合后仍存在胆管炎反复发作,但经抗感染治疗15个月后症状缓解。自体肝生存至今6年。结论胆道闭锁术后反复发作性胆管炎患儿仍可自体肝长时间存活,合并肝内胆管扩张时提示预后不良,需考虑肝移植术。

The result of medium to long term follow-ups after anti-infective therapy for recurrent cholangitis after Kasai operation

Objetive To discuss the survival of the patients’native liver and the appropriate time for their liver transplantation after they received anti-infective therapy for postoperative recurrent cholangitis. Methods A retrospective analysis was made on 18 cases who have had recurrent cholangitis after Kasai opera-tion in our hospital between 2002 and 2011,the episodes of cholangitis <4 w,and cholangitis was prolonged >4 m.A medium to long term follow-up visit was taken to observe the patients’survival condition. Results Except 2 cases have undergone liver transplantation at 4 months and 5 months after initial chonglangitis respec-tively;16 cases were continued under antibiotic therapy.12 cases of which have no cholangitis symptom after 6 to 15 months.10 /12 cases were alive with their native liver after 5 to 12 years,however liver cirrhosis were exi-ted;2 /12 cases have undergone liver transplantation for further ascties or gastrointestinal bleeding.Another 4 cases have undergone PTBD for developing intrahepatic biliary cysts.In which 1 case were dead;2 cases were finally accecpted liver transplantation;another 1 case was underwent redo hepatico-portoenterostomy but recur-rent cholangitis were occurred after surgical intervention for additional 15 months.Fortunately she was survival with native liver for 6 years until now.Conclusions Proper treatment for recurrent cholangitis may lead to a relative long term survival with native liver.When intrahepatic biliary cysts occured,liver transplantation should be considered.