Zhang Shujian,Dou Ran,Zhan Jianghua.Research advances in the relationship between Roux-en-Y limb length during Kasai portoenterostomy and cholangitis[J].Journal of Clinical Pediatric Surgery,2020,19(09):851-855.[doi:10.3969/j.issn.1671-6353.2020.09.018]
Kasai手术中空肠胆支保留长度与胆管炎发生关系的研究进展
- Title:
- Research advances in the relationship between Roux-en-Y limb length during Kasai portoenterostomy and cholangitis
- 分类号:
- R729;R657.4+5
- 摘要:
- 胆管炎是胆道闭锁Kasai手术后常见的并发症之一，是导致胆道闭锁远期疗效不佳的重要因素。胆管炎的病因复杂，其中反流性胆管炎这一影响因素被普遍关注。适当延长空肠胆支肠袢可减少胆管炎的发生，但统一规范的肠袢长度尚未制定。针对这一问题国内、外学者一直在进行研究，本文就Kasai手术空肠胆支保留长度与胆管炎发生关系作一综述。
- Abstract:
- As a common complication after Kasai procedure for biliary atresia,cholangitis is an important cause for poor long-term efficacy.The etiology of cholangitis is complex and reflux cholangitis has attracted a lot of attention.Appropriately prolonging Roux-en-Y limb reduces the incidence of cholangitis.However,normative and uniform length of intestinal loop has not been established.Domestic and foreign researchers have addressed this problem.Here the authors reviewed the relationship between Roux-en-Y limb length during Kasai procedure and occurring factors of cholangitis.
参考文献/References:
1 Feldman AG,Sokol RJ.Neonatal cholestasis:emerging molecular diagnostics and potential novel therapeutics[J].Nat Rev Gastroenterol Hepatol,2019,16(6):346-360.DOI:10.1038/s41575-019-0132-z.
2 Yang J,Gao W,Zhan J,et al.Kasai procedure improves nutritional status and decreases transplantation-associated complications[J].Pediatr Surg Int,2018,34(4):387-393.DOI:10.1007/s00383-018-4228-2.
3 詹江华,王立.胆道闭锁围术期营养状况评价的临床意义[J].天津医药,2019,47(4):342-345.DOI:10.11958/20181411.Zhan JH,Wang L.Clinical significance of evaluation of nutrition condition in patients with biliary atresia during perioperative period[J].Tianjin Medical Journal,2019,47(4):342-345.DOI:10.11958/20181411.
4 Ginstrom DA,Hukkinen M,Kivisaari R,et al.Biliary atresia-associated cholangitis:the central role and effective management of bile lakes[J].J Pediatr Gastroenterol Nutr,2019,68(4):488-494.DOI:10.1097/MPG.0000000000002243.
5 Sanchez-Valle A,Kassira N,Varela VC,et al.Biliary atresia:epidemiology,genetics,clinical update,and public health perspective[J].Adv Pediatr,2017,64(1):285-305.DOI:10.1016/j.yapd.2017.03.012.
6 葛亮,詹江华,高伟,等.胆道闭锁Kasai术后早期行肝移植手术的危险因素分析[J].天津医药,2019,47(4):351-355.DOI:10.11958/20190343.Ge L,Zhan JH,Gao W,et al.Risk factors of early liver transplantation after Kasai procedure for biliary atresia[J].Tianjin Medical Journal,2019,47(4):351-355.DOI:10.11958/20190343.
7 Yeh TJ,Chin TW,Tsai WC,et al.Mucosal intussusception to avoid ascending cholangitis[J].Br J Surg,1990,77(9):989-991.DOI:10.1002/bjs.1800770910.
8 Xiao H,Huang R,Chen L,et al.The application of a shorter loop in Kasai portoenterostomy reconstruction for Ohi type III biliary atresia:a prospective randomized controlled trial[J].J Surg Res,2018,232:492-496.DOI:10.1016/j.jss.2018.07.002.
9 Diao M,Li L,Zhang JZ,et al.A shorter loop in Roux-Y hepatojejunostomy reconstruction for choledochal cysts is equally effective:preliminary results of a prospective randomized study[J].J Pediatr Surg,2010,45(4):845-847.DOI:10.1016/j.jpedsurg.2009.12.022.
10 Baghdasaryan A,Fuchs CD,Osterreicher CH,et al.Inhibition of intestinal bile acid absorption improves cholestatic liver and bile duct injury in a mouse model of sclerosing cholangitis[J].J Hepatol,2016,64(3):674-681.DOI:10.1016/j.jhep.2015.10.024.
11 黄磊,司新敏,冯杰雄,等.胆道闭锁患儿Kasai术后早期胆管炎相关危险因素分析[J].中华小儿外科杂志,2011,32(1):17-20.DOI:10.3760/cma.j.issn.0253-3006.2011.01.005.Huang L,Si XM,Feng JX,et al.Risk factors of early cholangitis after Kasai operation for biliary atresia in children[J].Chin J Pediatr Surg,2011,32(1):17-20.DOI:10.3760/cma.j.issn.0253-3006.2011.01.005.
12 Hirsig J,Kara O,Rickham PP.Experimental investigations into the etiology of cholangitis following operation for biliary atresia[J].J Pediatr Surg,1978,13(1):55-57.DOI:10.1016/s0022-3468(78)80213-9.
13 Clements WD,Parks R,Erwin P,et al.Role of the gut in the pathophysiology of extrahepatic biliary obstruction[J].Gut,1996,39(4):587-593.DOI:10.1136/gut.39.4.587.
14 Wu ET,Chen HL,Ni YH,et al.Bacterial cholangitis in patients with biliary atresia:impact on short-term outcome[J].Pediatr Surg Int,2001,17(5-6):390-395.DOI:10.1007/s003830000573.
15 刘丹丹,詹江华,高伟,等.胆道闭锁患者肝门的病理解剖学研究[J].临床小儿外科杂志,2015,14(1):20-24.DOI:10.3969/j.issn.1671-6353.2015.01.006.Liu DD,Zhan JH,Gao W,et al.Pathoanatomic study of porta hepatis in biliary atresia[J].J Clin Ped Sur,2015,14(1):20-24.DOI:10.3969/j.issn.1671-6353.2015.01.006.
16 刘丹丹,詹江华,高伟,等.胆道闭锁Kasai术后胆管病理改变的研究[J].中华小儿外科杂志,2014,35(4):248-253.DOI:10.3760/cma.j.issn.0253-3006.2014.04.004.Liu DD,Zhan JH,Gao W,et al.Changes of bile duct pathology in children with biliary atresia after Kasai portoenterstomy[J].Chin J Pediatr Surg,2014,35(4):248-253.DOI:10.3760/cma.j.issn.0253-3006.2014.04.004.
17 Moreira RK,Cabral R,Cowles RA,et al.Biliary atresia:a multidisciplinary approach to diagnosis and management[J].Arch Pathol Lab Med,2012,136(7):746-760.DOI:10.5858/arpa.2011-0623-RA.
18 Kilgore A,Mack CL.Update on investigations pertaining to the pathogenesis of biliary atresia[J].Pediatr Surg Int,2017,33(12):1233-1241.DOI:10.1007/s00383-017-4172-6.
19 Davenport M,Gonde C,Redkar R,et al.Immunohistochemistry of the liver and biliary tree in extrahepatic biliary atresia[J].J Pediatr Surg,2001,36(7):1017-1025.DOI:10.1053/jpsu.2001.24730.
20 Bednarek J,Traxinger B,Brigham D,et al.Cytokine-producing B cells promote immune-mediated bile duct injury in murine biliary atresia[J].Hepatology,2018,68(5):1890-1904.DOI:10.1002/hep.30051.
21 Mack CL,Tucker RM,Lu BR,et al.Cellular and humoral autoimmunity directed at bile duct epithelia in murine biliary atresia[J].Hepatology,2006,44(5):1231-1239.DOI:10.1002/hep.21366.
22 Muraji T,Tsugawa C,Nishijima E,et al.Surgical management for intractable cholangitis in biliary atresia[J].J Pediatr Surg,2002,37(12):1713-1715.DOI:10.1053/jpsu.2002.36703.
23 王意,李万富,梁挺,等.胆道闭锁Kasai手术矩形瓣抗反流作用研究[J].中华小儿外科杂志,2017,38(11):832-835.DOI:10.3760/cma.j.issn.0253-3006.2017.11.006.Wang Y,Li WF,Liang T,et al.Effectiveness of rectangular flap of Kasai operation in infants with biliary atresia[J].Chin J Pediatr Surg,2017,38(11):832-835.DOI:10.3760/cma.j.issn.0253-3006.2017.11.006.
24 Ogasawara Y,Yamataka A,Tsukamoto K,et al.The intussusception antireflux valve is ineffective for preventing cholangitis in biliary atresia:a prospective study[J].J Pediatr Surg,2003,38(12):1826-1829.DOI:10.1016/j.jpedsurg.2003.08.025.
25 Shim WK,Zhang JZ.Anti-refluxing Roux-en-Y biliary dra-inage valve for hepatic portoenterostomy:animal experiments and clinical experience[J].J Pediatr Surg,1985,20(6):689-692.DOI:10.1016/s0022-3468(85)80025-7.
26 Nio M,Wada M,Sasaki H,et al.Technical standardization of Kasai portoenterostomy for biliary atresia[J].J Pediatr Surg,2016,51(12):2105-2108.DOI:10.1016/j.jpedsurg.2016.09.047.
27 Houben C,Phelan S,Davenport M.Late-presenting cholangitis and Roux loop obstruction after Kasai portoenterostomy for biliary atresia[J].J Pediatr Surg,2006,41(6):1159-1164.DOI:10.1016/j.jpedsurg.2006.01.066.
28 Davenport M,Ure BM,Petersen C,et al.Surgery for biliary atresia-is there a European consensus?[J].Eur J Pediatr Surg,2007,17(3):180-183.DOI:10.1055/s-2007-965147.
29 中华医学会小儿外科学分会肝胆外科学组,中国医师协会器官移植医师分会儿童器官移植学组.胆道闭锁诊断及治疗指南(2018版)[J].中华小儿外科杂志,2019,40(5):392-398.DOI:10.3760/cma.j.issn.0253-3006.2019.05.003.Group of Hepatobiliary Surgery,Branch of Pediatric Surgery,Chinese Medical Association,Group of Pediatric Organ Transplantation,Branch of Organ Transplantation Physicians,Chinese Doctors Association:Guidelines for Diagnosing & Treating Biliary Atresia (Edition 2018)[J].Chin J Pediatr Surg,2019,40(5):392-398.DOI:10.3760/cma.j.issn.0253-3006.2019.05.003.
30 詹江华,夏强.规范Kasai手术为肝移植做准备[J].中华小儿外科杂志,2019,40(5):385-387.DOI:10.3760/cma.j.issn.0253-3006.2019.05.001.Zhan JH,Xia Q.Standardizing Kasai’s procedure for preparing for liver transplantation[J].Chin J Pediatr Surg,2019,40(5):385-387.DOI:10.3760/cma.j.issn.0253-3006.2019.05.001.
31 Sundaram SS,Mack CL,Feldman AG,et al.Biliary atresia:indications and timing of liver transplantation and optimization of pretransplant care[J].Liver Transpl,2017,23(1):96-109.DOI:10.1002/lt.24640.
32 刘凯,王凯,马楠,等.胆道闭锁患儿肝移植术后胆管炎的发生情况分析[J].临床小儿外科杂志,2017,16(2):133-137.DOI:10.3969/j.issn.1671-6353.2017.02.007.Liu K,Wang K,Ma N,et al.Incidence of cholangitis after liver transplantation in patients with biliary atresia[J].J Clin Ped Sur,2017,16(2):133-137.DOI:10.3969/j.issn.1671-6353.2017.02.007.
33 Dutra RA,Araujo WM,Andrade JI.The effects of Roux-en-Y limb length on gastric emptying and enterogastric reflux in rats[J].Acta Cir Bras,2008,23(2):179-183.DOI:10.1590/s0102-86502008000200011.
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备注/Memo
收稿日期:2019-09-24。
基金项目:国家自然科学基金（编号：81570471）；天津市卫生行业重点攻关项目（编号：14KG129）
通讯作者:詹江华,Email:zhanjianghuatj@163.com