Guo Shuoshuo,Zeng Jixiao,Xu Xiaogang,et al.Analysis of short/medium-term efficacies and influencing factors in biliary atresia infants with a low level of γ-glutamyl transferase[J].Journal of Clinical Pediatric Surgery,,():243-248.[doi:10.3760/cma.j.cn101785-202505005]
Analysis of short/medium-term efficacies and influencing factors in biliary atresia infants with a low level of γ-glutamyl transferase
- Keywords:
- γ-Glutamyl Transferase; Biliary Atresia; Surgical Procedures; Operative; Prognosis; Root Cause Analysis
- Abstract:
- Objective To explore the short/medium-term efficacies and prognostic factors of Kasai operation in infants with biliary atresia (BA) and a low preoperative level of γ-glutamyl transferase (γ-GGT) (<300 IU/L).Methods A retrospective review was conducted for the relevant clinical data of BA infants undergoing Kasai portoenterostomy at Guangzhou Women and Childrens Medical Center from June 2016 to October 2023.Based upon a preoperative serum γ-glutamyl transferase (γ-GGT) cutoff level of 300 IU/L,they were stratified into two groups of low γ-GGT (<300 IU/L,n=51) and high γ-GGT (≥300 IU/L,n=124) for comparing their prognoses.Based upon postoperative outcomes,LG group was further categorized into two subgroups of native liver survival and liver transplantation/death.General profiles,preoperative liver function parameters,incidence of postoperative cholangitis and early bile drainage efficacy were compared between these two subgroups.Subsequently,they were stratified by surgical age (60 days) for comparing native liver survival time between LG and HG groups within each age stratum.Furthermore,differences in clinical and perioperative indicators between native liver survival and liver transplantation/death subgroups were examined within LG subgroups of different surgical ages.Results The 6-month and 1/3/5-year survival rates of native liver after Kasai portoenterostomy were 62.7%,41.2%,28.2% and 28.2% in LG group and 69.4%,54.0%,45.2% and 37.8% in HG group.No statistically significant inter-group difference existed in overall survival curves (Log-rank χ2=1.86,P>0.05).Within LG group,surgical age was significantly lower in native liver survival subgroup than that in liver transplantation/death subgroup[(55.80±12.35) vs.(71.28±15.36) day,P＜0.05].Rate of successful early bile drainage was significantly higher in native liver survival subgroup(9/15 vs. 21/26,P＜0.05).Among those with surgical age ≤60 days,no significant difference existed in survival rate of native liver between LG and HG groups (P>0.05).Furthermore,within LG subgroup with surgical age ≤60 days,no significant differences existed in any measured indicator between native liver survival and liver transplantation/death subgroups (P>0.05).In subgroup with surgical age >60 days,5-year SNL was significantly lower in LG group than that in HG group (15% vs.32.3%).The difference was statistically significant (Log-rank χ2= 4.12,P<0.05).Within LG subgroup with surgical age >60 days,rate of successful early bile drainage was significantly higher in native liver survival subgroup than liver transplantation/death subgroup (4/5 vs. 1/25,P<0.001).No significant differences existed in the remaining indicators between these two subgroups (P>0.05). Conclusions For BA infants with a low level of γ-GGT,those with surgical age >60 days have a worse prognosis than those with a high level of γ-GGT.And successful early bile drainage is an important factor for a better prognosis.
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Memo
收稿日期:2025-5-5。
基金项目:国家自然科学基金(82170528);广州地区临床特色技术项目(2023C-TS48);广州市科技计划市校(院)企联合资助项目(2024A03J1236)
通讯作者:刘斐,Email:star5044207@163.com