Wang Yixi,Chen Junze,Zhang Cheng,et al.Clinical evaluations of laparoscopic Kasai portoenterostomy for type Ⅲ biliary atresia[J].Journal of Clinical Pediatric Surgery,,20():340-347.[doi:10.12260/lcxewkzz.2021.04.008]
Clinical evaluations of laparoscopic Kasai portoenterostomy for type Ⅲ biliary atresia
- Keywords:
- Biliary Atresia/SU; Laparoscopy; Treatment Outcome
- CLC:
- R726;R657.4+4
- Abstract:
- Objective To evaluate the efficacy of laparoscopic Kasai portoenterostomy for type Ⅲ biliary atresia (BA) and examine its effect on liver transplantation.Methods Clinical data were retrospectively analyzed for 115 type Ⅲ BA patients undergoing Kasai surgery from January 2014 to January 2018.They were divided into laparoscopic portoenterostomy group (LPE, n=54) and open portoenterostomy group (OPE, n=61).Patients undergong liver transplantation were divided into two subgroups of liver transplantation after laparoscopic portoenterostomy subgroup (LTLPE) and liver transplantation after open portoenterostomy subgroup (LTOPE).The perioperative data were compared and analyzed.The following-up cut-off time was January 1, 2020.Results No statistically significant inter-group differences existed in operative age, weight, intraoperative blood loss, episodes of cholangitis or jaundice clearance rate (P>0.05).TBIL and ALT of pre-operation and at Month 1/3/6 post-operation showed no statistical difference (P>0.05).The operative duration of LPE was significantly longer than that of OPE (229 vs.126 min, P=0.001), the first feeding time of LPE significantly shorter than that of OPE (2 vs.3 days, P=0.001) and hospitalization length of LPE were significantly shorter than that of OPE (19 vs.21 days, P=0.001).The 1-year survival rate of native liver of LPE and OPE were 79.6% and 72.1% (P=0.35), the 2-year survival rate of native liver 70.4% and 57.4% (P=0.149) and the 4-year survival rate of native liver 63.0% and 55.7% respectively (P=0.432).And the 1-year survival rate of two groups were 83.3% and 75.4% (P=0.297), the 2-year survival rate 74.1% and 62.3% (P=0.177) and the 4-year survival rate 72.2% and 60.7% respectively (P=0.191).The clinical data of 9 patients undergoing Kasai postoperative liver transplantation were retrospectively analyzed.There were LTLPE (n=5) and LTOPE (n=4) subgroups.No statistically significant difference existed in age, weight or PELD score (P>0.05).However, LTLPE had a lower score of abdominal cavity adhesion (3 vs.10, P=0.024), shorter operative duration (587 vs.844 min, P=0.027), shorter liver resection time (132 vs.278 min, P=0.037) and less bleeding (430 vs.947.5 mL, P=0.027).Conclusion Laparoscopic Kasai portoenterostomy has a similar efficacy to open Kasai portoenterostomy for type Ⅲ BA.And it is conducive to the implementation of liver transplantation.
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Memo
收稿日期:2020-12-25。
基金项目:腹腔镜胆道闭锁肝门空肠吻合术的临床应用研究（编号：Z20170576）
通讯作者:董淳强,Email:dongchunqiang@163.com