Wu Xiaoxia,Ren Hongxia,Jin Yuanyuan,et al.Risk factors of native liver survival time under 2 years after Kasai operation for biliary atresia[J].Journal of Clinical Pediatric Surgery,2021,20(02):114-118.[doi:10.12260/lcxewkzz.2021.02.003]
胆道闭锁Kasai手术后自体肝生存时间小于2年的危险因素分析
- Title:
- Risk factors of native liver survival time under 2 years after Kasai operation for biliary atresia
- Keywords:
- Biliary Atresia/SU; Prognosis; Native Liver Survival; Risk Factors
- 分类号:
- R657.4+4 R726.1
- 摘要:
- 目的 探讨胆道闭锁（biliary atresia，BA）Kasai手术后自体肝生存（native liver survival，NLS）时间小于2年的危险因素。方法 回顾性分析山西省儿童医院2009年1月至2017年6月行Kasai手术的BA患者临床资料及随访资料。根据术后NLS时间是否小于2年分为死亡组（n=78）和生存组（n=46）。将BA分型、性别、巨细胞病毒（cytomegalovirus，CMV）感染、手术年龄、术后使用抗生素方案、术后使用激素方案、是否合并早期胆管炎及术后黄疸是否消退作为自变量，采用Kaplan-Meier法绘制生存曲线并进行Log-rank检验，采用Cox比例风险模型（逐步前进法）筛选BA患者Kasai手术后NLS时间小于2年的危险因素。结果 共纳入124例BA患者，其中生存组46例，死亡组78例，2年NLS率为37.1%。单因素分析结果显示合并早期胆管炎及术后黄疸消退是影响BA患者术后2年NLS率的因素（P<0.05）。Cox比例风险模型分析结果显示术后3个月内黄疸未消退为BA患者Kasai手术后NLS时间小于2年的独立危险因素，术后3个月内黄疸未消退组患者NLS时间小于2年的风险是黄疸消退患者的5.65（95%CI：2.45~13.04）倍。结论 BA患者Kasai手术后3个月内黄疸未消退是NLS时间小于2年的危险因素。
- Abstract:
- Objective To explore the risk factors of native liver survival (NLS) time under 2 years after Kasai operation for biliary atresia (BA).Methods Clinical and follow-up data were retrospectively analyzed for all children undergoing Kasai operation for BA from January 2009 to June 2017.According to whether or not NLS time was under 2 years,they were divided into survival and death groups.BA classification,gender,cytomegalovirus (CMV) infection,age at Kasai,postoperative antibiotic and hormone regimens,postoperative early cholangitis and jaundice clearance were independent variables.Kaplan-Meier survival analysis was employed for plotting the survival curves of two groups and log-rank test performed for assessing the inter-group difference.Cox proportional hazard models were constructed for assessing the risk factors of native liver survival time under 2 years.Within 3 months,the risk of NLS time under 2 years for non-clearing group was 5.65 folds of that for clearing group (95%CI:2.45-13.04).Results There were 46 cases in survival group and 78 in death group.And 2-year NLS rate was 37.1%.Univariate analysis showed that statistically significant difference existed in survival curve between two variables associated with postoperative early cholangitis and jaundice clearance (P<0.05).COX proportional risk model analysis indicated that failure of jaundice clearance within 3 months after Kasai operation was an independent risk factor for NLS time <2 years.Conclusion Failure of jaundice clearance within 3 months is a risk factor for NLS time under 2 years after Kasai operation for biliary atresia.
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备注/Memo
收稿日期:2020-05-06。
基金项目:山西省重点研发计划项目（编号：201803D31181）；山西省儿童医院院内课题（编号：201928）；山西省儿童医院院内课题（编号：201943）
通讯作者:任红霞,Email:renhongxia100@sina.com