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,2021,20(04):340-347.[doi:10.12260/lcxewkzz.2021.04.008]
腹腔镜Kasai手术在Ⅲ型胆道闭锁中的临床应用评价
- Title:
- Clinical evaluations of laparoscopic Kasai portoenterostomy for type Ⅲ biliary atresia
- Keywords:
- Biliary Atresia/SU; Laparoscopy; Treatment Outcome
- 分类号:
- R726;R657.4+4
- 摘要:
- 目的 对腹腔镜Kasai手术治疗Ⅲ型胆道闭锁的疗效及其对肝移植影响进行临床评价。方法 对2014年1月至2018年1月在广西医科大学第一附属医院接受Kasai手术的Ⅲ型胆道闭锁病例进行回顾性分析，根据不同手术方式分为腹腔镜组（laparoscopic portoenterostomy，LPE）与开放组（open portoenterostomy，OPE），将组内行肝移植的病例分为LPE后肝移植亚组（liver transplantation after laparoscopic portoenterostomy，LTLPE）与OPE后肝移植亚组（liver transplantation after open portoenterostomy，LTOPE），收集各组术前、术中、术后临床资料进行对比分析。随访截止时间为2020年1月1日。结果 全组病例115例，LPE组54例，OPE组61例。两组间比较手术年龄、体重、术中出血量，术前及术后1个月、3个月、6个月TBIL、ALT，术后胆管炎发生率、黄疸清除率差异无统计学意义（P>0.05）。手术时间LPE组长于OPE组（229 min vs.126 min，P<0.001）；术后首次进食时间LPE组短于OPE组（2 d vs.3 d，P<0.001）；住院天数LPE组短于OPE组（19 d vs.21 d，P<0.001）。LPE组与OPE组1年自体肝生存率（survival rate of native liver，SNL）分别为79.6%和72.1%（P=0.35）；2年SNL分别为70.4%和57.4%（P=0.149），4年SNL分别为63.0%和55.7%（P=0.432）。LPE组与OPE组1年生存率分别为83.3%和75.4%（P=0.297），2年生存率分别为74.1%和62.3%（P=0.177），4年生存率分别为72.2%和60.7%（P=0.191）。Kasai手术后肝移植9例，LTLPE亚组5例，LTOPE亚组4例。两组受者移植手术年龄、体重、术前儿童终末期肝病模型（pediatric end-stage liver disease，PELD）评分差异无统计学意义（P>0.05），腹腔粘连评分LTLPE亚组低于LTOPE亚组（3分vs.10分，P=0.024）、肝移植手术时间LTLPE亚组短于LTOPE亚组（587 min vs.844 min，P=0.027）、病肝切除时间LTLPE亚组短于LTOPE亚组（132 min vs.278 min，P=0.037）、出血量LTLPE亚组少于LTOPE亚组（430 mL vs.947.5 mL，P=0.027）。结论 腹腔镜Kasai手术治疗Ⅲ型胆道闭锁的效果与开放手术相当，有利于肝移植实施。
- 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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备注/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