胆道闭锁患儿肝移植术后胆管炎的发生情况分析
刘 凯1,王 凯2,马 楠2,孟醒初2,张 威2,孙 超2,董 冲2,吴 斌2,韩 潮2 覃 虹2,沈中阳2,高 伟2

1,天津医科大学一中心临床学院(天津市,300192); 2,天津市第一中心医院移植外科(天津市,300192)

胆道闭锁; 外科手术; 胆管炎; 肝移植

Incidence of cholangitis after liver transplantation in patients with biliary atresia.
Liu Kai1, Wang Kai2, Ma Nan2, Meng Xingchu2, Zhang Wei2, Sun Chao2, Dong Chong2, Wu Bin2, Qin Hong2, Shen Zhongyang2, Gao Wei2

1.First Central Clinical College, Tianjin Medical University, Tianjin 300192, China; 2.Department of Transplant Surgery, First Central Municipal Hospital, Tianjin 300192, China.Corresponding author: Gao Wei, Email: gao-wei@medmail.com.cn

Biliary Atresia; Surgical Procedures,Operative; Cholangitis; Liver Transplantaion

DOI: 10.3969/j.issn.1671-6353.2017.02.007

备注

目的 分析胆道闭锁患儿肝移植术后胆管炎的发生情况。 方法 回顾性分析2013年1月至2016年7月于本院移植科接受肝移植手术的219例胆道闭锁患儿临床资料。根据肝移植术前是否接受过肝门 — 空肠吻合术(Kasai手术)、肝移植术前是否发生胆管炎以及肝移植术中肠袢的不同处理方式进行分组,并比较各组间肝移植术后胆管炎的发生率。 结果 219例胆道闭锁患儿肝移植术后胆管炎的总体发生率为23.29%。Kasai手术组肝移植术后胆管炎的发生率高于非Kasai手术组(30.70% vs 15.24%),差异有统计学意义( χ2=7.316,P=0.007)。而Kasai手术组患儿中,术前胆管炎组与术前非胆管炎组肝移植术后胆管炎的发生率组间比较(28.57% vs 32.76%),差异无统计学意义( χ2=0.235,P=0.628); 肠袢保留组与肠袢重建组肝移植术后胆管炎的发生率组间比较(31.43% vs 30.38%),差异无统计学意义( χ2= 0.013,P=0.911)。在Kasai术后存在胆管炎的患儿中,原肠袢组与新肠袢组肝移植术后胆管炎发生率组间比较(33.33% vs 24.14%),差异无统计学意义( χ2=0.579, P=0.447)。 结论 对于胆道闭锁患儿Kasai术后的顽固性胆管炎,肝移植手术可取得较为满意的结果。胆道闭锁患儿肝移植术后胆管炎较为常见,但基本可以治愈。保证胆肠吻合的输入端肠袢长度足够,可有效控制肝移植术后胆管炎的发生。
Objective To explore the incidence of cholangitis in patients with biliary atresia(BA)after liver transplantation(LT). Methods From January 2013 to July 2016, a total of 219 BA children undergoing LT were recruited.They were divided into two groups according to Kasai operation pre-LT. Then those with a history of Kasai operation were divided into two groups according to cholangitis post-LT and types of Roux-en-Y loop respectively. The percentages of cholangitis post-LT were analyzed in different groups. Results Fifty-one(23.29%)patients had an onset of cholangitis post-LT. The incidence of cholangitis post-LT was higher in Kasai group than that in non-Kasai group(30.70% vs 15.24%,( χ2=7.316,P=0.007). No significant differences existed in the incidences of cholangitis post-LT between cholangitis and non-cholangitis groups(28.57% vs 32.76%,( χ2=0.235,P=0.628), reused and rebuilt groups(31.43% vs 30.38%,( χ2=0.013,P=0.911)and old and new loop groups(33.33% vs 24.14%,( χ2=0.579,P=0.447). Conclusion s LT is efficacious for recurrent cholangitis after Kasai operation. Cholangitis post-LT is common and curable for BA children. For BA children after Kasai operation, a sufficient length of Roux-en-Y loop can effectively control the occurrence of cholangitis post-LT