Kasai术对胆道闭锁患儿肝移植手术及预后的影响

摘要：目的　研究肝门空肠吻合术（Kasai术）对肝移植治疗胆道闭锁（BA）患儿手术及预后的影响。方法　回顾性分析因BA接受肝移植手术的880例患儿的临床资料，根据肝移植术前是否行Kasai术，分为Kasai组542例和非Kasai组338例。比较2组患儿一般资料、术后并发症发生率、移植物存活率和患者生存率的差异。结果　Kasai组患儿移植时月龄、身高、体质量、移植物冷缺血时间、移植物质量和手术时间均高于或长于非Kasai组，而移植物与受者质量比、术前Child评分和儿童术前终末期肝病模型（PELD）评分低于非Kasai组（P＜0.05）。2组患儿性别、移植物热缺血时间、出血量/体质量、术中输血量、无肝期时间、呼吸机使用时间、重症监护室（ICU）住院时间和术后住院时间差异无统计学意义。患儿术后流出道梗阻、门静脉吻合口狭窄、门静脉血栓、肝动脉血栓形成、胆漏、胆道狭窄、淋巴漏、胃肠道瘘、肠梗阻、急性排斥反应、巨细胞病毒和EB病毒感染等并发症发生率差异无统计学意义。2组术后1年和5年移植物存活率、累积生存率比较差异无统计学意义。结论　肝移植是治疗BA患儿安全有效的手术方式，Kasai术可推迟患儿行肝移植手术的时间，且对肝移植手术、术后移植物存活率、患儿生存率及术后主要并发症的发生无影响。

The effects of Kasai procedure on the liver transplantation for children with biliary atresia

Abstract: Objective　To study the effects of portoenterostomy (Kasai surgery) on liver transplantation (LT) for children with biliary atresia (BA). Methods　The clinical data of 880 children who received liver transplantation for BA in our hospital were retrospectively analyzed. According to whether Kasai surgery was performed before liver transplantation, they were divided into the Kasai group (n=542) and the non-Kasai group (n=338). The differences in general information, incidence of postoperative complications, graft survival rate and patient survival rate were compared between the two groups. Results　The months of age at the time of transplantation, height, body weight, graft cold ischemia time, graft quality and operation time of children were higher or longer in Kasai group than those in non-Kasai group, while the graft-recipient mass ratio, preoperative Child score and pediatric model of end-stage liver disease (PELD) score were lower in the Kasai group than those in the non-Kasai group (P＜0.05). There were no significant differences in gender, graft hot ischemia time, blood loss/body weight, intraoperative blood transfusion volume, duration of no-liver phase, duration of ventilator use, ICU hospitalization and postoperative hospitalization duration between the two groups. There were no significant differences in the outflow tract obstruction after operation, portal vein anastomotic stenosis, portal vein thrombosis, hepatic artery thrombosis, biliary leakage, biliary tract stenosis, lymphatic leakage, gastrointestinal fistula, intestinal obstruction, acute rejection, cytomegalovirus and Epstein-Barr virus infection between the two groups. There were no significant differences in graft survival rate and cumulative survival rate at 1 and 5 years after operation between the two groups. Conclusion　Liver transplantation is a safe and effective surgical method for the treatment of children with BA. Kasai surgery can postpone the time of liver transplantation in children, and have no effects on liver transplantation, postoperative graft survival, survival rate of children and the occurrence of major postoperative complications.