He Xiaojin,Liu Xuelai,Ye Mao,et al.The effect of different prophylactic intravenous antibiotic regimens on the survival of children with cholangitis and autologous liver after biliary atresia surgery[J].Journal of Clinical Pediatric Surgery,2025,(05):442-447.[doi:10.3760/cma.j.cn101785-202407004-009]
胆道闭锁手术后不同预防性静脉抗生素方案对患儿胆管炎及自体肝生存情况的影响
- Title:
- The effect of different prophylactic intravenous antibiotic regimens on the survival of children with cholangitis and autologous liver after biliary atresia surgery
- Keywords:
- Biliary Atresia; Cholangitis; Prevention; Antibiotic Prevention; Treatment Outcome Prophylaxis
- 摘要:
- 目的 探讨胆道闭锁手术后不同预防性静脉抗生素方案对患儿胆管炎及自体肝生存情况的影响。方法 本研究为回顾性研究,收集2015年6月至2018年1月首都医科大学附属首都儿童医学中心治疗的符合入组标准的Ⅲ型胆道闭锁患儿106例为研究对象。根据术后所使用的抗生素种类分为头孢哌酮钠舒巴坦钠组(n=44)和亚胺培南西司他丁钠组(n=62),以术后胆管炎发生率、复杂程度、发作时间和频率以及黄疸消退时间等为指标,比较两组术后6个月内的近期疗效及术后6年自体肝生存情况。结果 头孢哌酮钠舒巴坦钠组和亚胺培南西司他丁钠组术后6个月胆管炎发生率（72.7%比58.1%，32/44比36/62）、发病复杂程度［单纯性胆管炎（34.1%比21.0%，15/44比13/62）、难治性胆管炎（38.6%比37.1%，17/44比23/62）］差异无统计学意义（P>0.05）。头孢哌酮钠舒巴坦钠组和亚胺培南西司他丁钠组术后6个月胆管炎的发生频率［偶发胆管炎（22.7%比21.0%，10/44比13/62）、频发胆管炎（50.0%比37.1%，22/44比23/62）］、黄疸清除率［术后3个月清除率（29.5%比35.5%，13/44比22/62）、术后6个月清除率（45.5%比51.6%，20/44比32/62）］及术后6年自体肝的生存情况比较［自体肝生存正常（47.7%比54.8%，21/44比34/62）、术后6个月内行肝移植（2.3%比3.2%，1/44比2/62）、术后1年内肝移植（31.8%比29.0%，14/44比18/62）、术后6年内肝移植（50.0%比43.5%，22/44比27/62）、死亡（2.3%比1.6%，1/44比1/62）］，差异均无统计学意义（P>0.05）。头孢哌酮钠舒巴坦钠组术后1个月内胆管炎的发生率高于亚胺培南西司他丁钠组(45.5%比25.8%,20/44比16/62),差异有统计学意义(P<0.05),但两组术后3个月内胆管炎的发生率(68.2%比58.1%,30/44比36/62)及术后6个月内胆管炎的发生率(72.7%比58.1%,32/44比36/62)差异无统计学意义(P>0.05)。结论 Kasai术后预防性使用不同抗生素对预防胆管炎和改善自体肝生存情况疗效相似,但碳青霉烯类较头孢类更能有效降低早期胆管炎的发生率。
- Abstract:
- Objective To investigate the impact of different prophylactic intravenous antibiotic regimens on the prevention of cholangitis and the survival of native livers in children following surgery for biliary atresia. Methods This retrospective study including 106 type Ⅲ biliary atresia patients treated at Capital center for children’s health, Capital medical uviversity from June 2015 to January 2018.Patients were divided into a cefoperazone-sulbactam group (n=44) and an imipenem-cilastatin group (n=62) based on postoperative prophylactic antibiotic type.Key outcome measures included cholangitis incidence,severity,onset timing,recurrence frequency,and jaundice resolution time.The study assessed short-term outcomes within 6 months postoperatively and long-term outcomes concerning native liver survival over a 6-year follow-up period. Results No significant differences were observed between the cefoperazone-sulbactam group and the imipenem-cilastatin group in the 6-month postoperative cholangitis incidence (72.7% vs.58.1%,32/44 vs.36/62),the severity of cholangitis ［simple cholangitis (34.1% vs.21.0%,15/44 vs.13/62) and refractory cholangitis (38.6% vs.37.1%,17/44 vs.23/62)］,the frequency of cholangitis episodes ［occasional cholangitis (22.7% vs.21.0%,10/44 vs.13/62) and recurrent cholangitis (50.0% vs.37.1%,22/44 vs.23/62)］,jaundice clearance rates ［3-month clearance rate (29.5% vs.35.5%,13/44 vs.22/62) and 6-month clearance rate (45.5% vs.51.6%,20/44 vs.32/62)］,or the native liver survival status at 6 years ［normal native liver survival (47.7% vs.54.8%,21/44 vs.34/62),transplantation within 6 months (2.3% vs.3.2%,1/44 vs.2/62),transplant within 1 year (31.8% vs.29.0%,14/44 vs.18/62),transplantation within 6 years (50.0% vs.43.5%,22/44 vs.27/62）,and death (2.3% vs.1.6%,1/44 vs.1/62)］(P>0.05). However,there was no significant difference in the incidence of cholangitis between the two groups within 3 months after operation (68.2% vs.58.1%,30/44 vs.36/62) and 6 months after operation (72.7% vs.58.1%,32/44 vs.36/62) (P>0.05). Conclusions The prophylactic use of different antibiotics after Kasai surgery demonstrated comparable efficacy in preventing cholangitis and maintaining native liver survival.However,carbapenems were more effective than cephalosporin in reducing early-onset cholangitis.
参考文献/References:
[1] Baek SH,Kang JM,Ihn K,et al.The epidemiology and etiology of cholangitis after Kasai portoenterostomy in patients with biliary atresia[J].J Pediatr Gastroenterol Nutr,2020,70(2):171-177.DOI:10.1097/MPG.0000000000002555.
[2] 吴晓霞,刘文跃,孙雪,等.胆道闭锁患儿Kasai手术后频发胆管炎的危险因素及预后分析[J].临床小儿外科杂志,2023,22(3):244-248.DOI:10.3760/cma.j.cn101785-202212005-008. Wu XX,Liu WY,Sun X,et al.Risk factors and prognosis of recurrent cholangitis after Kasai in biliary atresia patients[J].DOI:10.3760/cma.j.cn101785-202212005-008.
[3] Luo Y,Zheng S.Current concept about postoperative cholangitis in biliary atresia[J].World J Pediatr,2008,4(1):14-19.DOI:10.1007/s12519-008-0003-0.
[4] Chen SY,Lin CC,Tsan YT,et al.Number of cholangitis episodes as a prognostic marker to predict timing of liver transplantation in biliary atresia patients after Kasai portoenterostomy[J].BMC Pediatr,2018,18(1):119.DOI:10.1186/s12887-018-1074-2.
[5] 中华医学会小儿外科学分会肝胆外科学组.胆道闭锁Kasai术后胆管炎诊疗专家共识(2022版)[J].中华小儿外科杂志,2022,43(9):769-774.DOI:10.3760/cma.j.cn421158-20220427-00308. Section of Hepatobiliary Surgery,Branch of Pediatric Surgery,Chinese Medical Association.Expert consensus on diagnosing and treating cholangitis after Kasai operation for biliary atresia (2022 edition)[J].Chin J Pediatr Surg,2022,43(9):769-774.DOI:10.3760/cma.j.cn421158-20220427-00308.
[6] 王安,庞雅琦,庞文博.胆道闭锁术后预防性使用抗生素的研究进展[J].中华小儿外科杂志,2024,45(3):273-276.DOI:10.3760/cma.j.cn421158-20230724-00117. Wang A,Pang YQ,Pang WB.Research advances on prophylactic use of antibiotics after Kasai portoenterostomy for biliary atresia[J].Chin J Pediatr Surg,2024,45(3):273-276.DOI:10.3760/cma.j.cn421158-20230724-00117.
[7] Pang WB,Zhang TC,Chen YJ,et al.Ten-year experience in the prevention of post-Kasai cholangitis[J].Surg Infect (Larchmt),2019,20(3):231-235.DOI:10.1089/sur.2018.047.
[8] Chen G,Liu J,Huang YL,et al.Preventive effect of prophylactic intravenous antibiotics against cholangitis in biliary atresia:a randomized controlled trial[J].Pediatr Surg Int,2021,37(8):1089-1097.DOI:10.1007/s00383-021-04916-z.
[9] Hitch DC,Lilly JR,Reller LB,et al.Biliary flora and antimicrobial concentrations after Kasai’s operation[J].J Pediatr Surg,1979,14(6):648-652.DOI:10.1016/S0022-3468(79)80238-9.
[10] Decharun K,Leys CM,West KW,et al.Prophylactic antibiotics for prevention of cholangitis in patients with biliary atresia status post-Kasai portoenterostomy:a systematic review[J].Clin Pediatr (Phila),2016,55(1):66-72.DOI:10.1177/0009922815594760.
[11] Bu LN,Chen HL,Chang CJ,et al.Prophylactic oral antibiotics in prevention of recurrent cholangitis after the Kasai portoenterostomy[J].J Pediatr Surg,2003,38(4):590-593.DOI:10.1053/jpsu.2003.50128.
[12] Wong KKY,Fan AH,Lan LCL,et al.Effective antibiotic regime for postoperative acute cholangitis in biliary atresia-an evolving scene[J].J Pediatr Surg,2004,39(12):1800-1802.DOI:10.1016/j.jpedsurg.2004.08.027.
[13] Salvador VBDG,Lozada MCH,Consunji RJ.Microbiology and antibiotic susceptibility of organisms in bile cultures from patients with and without cholangitis at an Asian academic medical center[J].Surg Infect (Larchmt),2011,12(2):105-111.DOI:10.1089/sur.2010.005.
[14] Liu J,Dong R,Chen G,et al.Risk factors and prognostic effects of cholangitis after Kasai procedure in biliary atresia patients:a retrospective clinical study[J].J Pediatr Surg,2019,54(12):2559-2564.DOI:10.1016/j.jpedsurg.2019.08.026.
[15] Lee JY,Lim LTK,Quak SH,et al.Cholangitis in children with biliary atresia:health-care resource utilisation[J].J Paediatr Child Health,2014,50(3):196-201.DOI:10.1111/jpc.12463.
[16] Guan XS,He QM,Zhong W,et al.Long-term prophylactic intravenous antibiotics after Kasai portoenterostomy for biliary atresia do not reduce the risks of post-operative cholangitis,a retrospective study[J].Transl Pediatr,2021,10(8):2076-2082.DOI:10.21037/tp-21-309.
[17] 詹江华,李梦迪.胆道闭锁Kasai术后胆管炎的发病机制探讨[J].天津医药,2022,50(1):1-4.DOI:10.11958/20211092. Zhan JH,Li MD.The study on pathogenesis of cholangitis after Kasai procedure in children with biliary atresia[J].Tianjin Med J,2022,50(1):1-4.DOI:10.11958/20211092.
[18] Davenport M.Adjuvant therapy in biliary atresia:hopelessly optimistic or potential for change?[J].Pediatr Surg Int,2017,33(12):1263-1273.DOI:10.1007/s00383-017-4157-5.
[19] Wang P,Zhang HY,Yang JX,et al.Severity assessment to guide empiric antibiotic therapy for cholangitis in children after Kasai portoenterostomy:a multicenter prospective randomized control trial in China[J].Int J Surg,2023,109(12):4009-4017.DOI:10.1097/JS9.0000000000000682.
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[J].Journal of Clinical Pediatric Surgery,2012,11(05):187.
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备注/Memo
收稿日期:2024-7-3。
基金项目:首都儿科研究所所级课题(LCYJ-2023-22); 北京市自然科学基金(7222015); 北京市卫生健康委员会"一带一路"国际卫生健康合作项目和世界卫生组织合作中心项目
通讯作者:张建民,Email:zjm051525@126.com