Qiao Qi,Zhang Zhibo.Analysis of risk factors of cholestatic liver injury in children with complex intestinal atresia and nutrition management[J].Journal of Clinical Pediatric Surgery,,():35-39.[doi:10.3760/cma.j.cn101785-202305041-007]
Analysis of risk factors of cholestatic liver injury in children with complex intestinal atresia and nutrition management
- Keywords:
- Complex Intestinal Atresia; Perioperative Period; Management; Surgical Procedures; Operative; Child
- Abstract:
- Objective To explore the factors associated with cholestatic liver injury in children with complex intestinal atresia (CIA) and nutrition management..Methods From January 2018 to December 2022,the relevant clinical data were retrospectively reviewed for 45 hospitalized CIA children.Age,gender,operative age,gestation age,birth weight,clinical manifestations,treatment protocols,diagnoses,pathological results and outcomes were examined.Conjugated bilirubin 34.2 μmol/L (2 mg/dl) was employed as a diagnostic criterion for cholestasis.They were assigned into two groups of cholestatic (n=14) and non-cholestatic (n=31).Results Total parenteral nutrition of low energy was given before and 2 days after surgery,and recovery stage nutrition was given 2 days later.Enteral nutrition started upon a relief of intestinal obstruction symptoms.Among them,31 cases were detected by routine prenatal ultrasonic examination.Fourteen cases were symptomatic immediately after birth and 32 cases developed the complications of meconium peritonitis,intestinal necrosis and intestinal perforation.The clinical types were ⅢB (n=12) and Ⅳ(n=10) And the former was mixed with type Ⅳ(n=5).34 cases were located in ileum (34/45,75.56%),10 in jejunum (10/45,22.22%),and 1 in duodenum (1/45,2.22%).Mean time of oral feeding was (11±4.57) day and mean duration of TPN (12.82±5.41) day.And 14 children developed cholestatic liver injury.Univariate analysis indicated that preterm delivery,prenatal intestinal abnormalities,duodenojejunal atresia and long-term TPN were risk factors (P<0.05).Multivariate Logistic regression analysis revealed that prenatal intestinal abnormalities (OR=1.021,95%CI:1.001-1.042),preterm delivery (OR=1.005,95%CI:1.000-1.011),closure site (OR=4.423,95%CI:3.876-5.212) and TPN duration (OR=6.798,95%CI:6.191-7.794) were independent risk factors associated with elevated bilirubin.And long-term TPN was the greatest risk factor.Conclusions The risk factors of cholestatic liver injury are chronic incomplete obstruction and long-term TPN.Optimizing operative approaches and shortening the duration of parenteral nutrition are vital for preventing cholestatic liver injury.
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Memo
收稿日期:2023-5-24。
基金项目:国家自然科学基金(82170529); 辽宁科技厅项目(2021YFC2701003)
通讯作者:张志波,Email:zhangzb@sj-hospital.org