Zheng Lulu,Wu Yibo,Wu Wei,et al.Middle/long-term prognosis and influencing factors of Kasai portoenterostomy on type Ⅲ biliary atresia[J].Journal of Clinical Pediatric Surgery,,22():1045-1049.[doi:10.3760/cma.j.cn101785-202203017-008]
Middle/long-term prognosis and influencing factors of Kasai portoenterostomy on type Ⅲ biliary atresia
- Keywords:
- Biliary Atresia; Prognosis; Root Cause Analysis; Surgical Procedures; Operative; Child
- Abstract:
- Objective To explore the middle/long-term native liver survival and examine its influencing factors of Kasai portoenterostomy for type Ⅲ biliary atresia (BA).Methods From January 2011 to December 2020,single-center retrospective analysis was performed for 234 type Ⅲ BA children undergoing Kasai portoenterostomy.Gender,operative age,liver function test,blood routine test,cytomegalovirus (CMV) IgM examination and aspartate aminotransferase-to-platelet ratio index (APRi) were recorded.Operative age ≤eerativewas defined as early operation group while operative age >60 days as late operation group.IgM antibodies against CMV were detected by immunoenzyme-linked reaction.They were assigned into two groups of IgM positive and IgM negative according to the detection results.Ratio index of aspartate aminotransferase-to-platelet=AST/(upper limit of AST) ×100/PLT(109/L).Aspartate aminotransferase and platelets were measured at the same time 1 week pre-Kasai.They were divided into two groups of APRi <0.6 and APRi of.Total bilirubin ≤2 mg/dL being more than once post-Kasai within 6 mouths was defined as jaundice-eliminating group and the rest as jaundice group.And 5/10-year native liver survival was calculated by Kaplan Meier method.Univariate analysis was performed by Log rank test and multibariate analysis by Cox regression.Results There were 118 boy and 116 girls with an average operative age of (72.7±23) days.The 5/10-year native liver survival rate was 41.2% and 38.9% respectively.Univariate Kaplan-Meier liver survival and Log Rank test analysis revealed that gender (χ2=0.01,P=0.91),CMV (χ2=1.3,P=0.25) and APRi (χ2=0,P=0.98) had no effect on native liver survival.Compared with late operative age group,native liver survival rate spiked markedly in early operative age group (χ2=7.6,P=0.006).Compared with total bilirubin level greater than or equal to 2 mg/dL,native liver survival rate rose significantly in <2 mg/dL of total bilirubin (χ2=74.6,P=<0.001).Multivariate Cox regression analysis showed that only total bilirubin <2 mg/dL within 6 months post-Kasai was an independent influencing factor of middle/long-term liver survival.Conclusions Total bilirubin <2 mg/dL within 6 months after Kasai portoenterostomy is an independent influencing factor of middle/long-term liver survival.
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Memo
收稿日期:2022-3-7。
基金项目:上海市儿童医院院级课题临床研究培育专项(2021YLYM02)
通讯作者:吴一波,Email:yibo_wu1007@163.com