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目的评价肝门-空肠吻合术(Kasai手术)对胆道闭锁儿童行活体肝移植术治疗效果及预后的影响。方法对2006年9月—2014年9月实施的150例活体肝移植患者资料进行回顾性分析,其中90例受者先行Kasai手术,后接受活体肝移植(Kasai组);60例受者直接接受活体肝移植(非Kasai组)。比较2组受者的一般资料、术后并发症和累积生存率的差异。结果受者年龄为4.9~87.0个月。Kasai组受者在移植时的移植月龄、体质量、身高均高于非Kasai组,而儿童终末期肝病(PELD)评分、术前胆红素水平则低于非Kasai组(均P<0.05)。2组移植物质量与受者体质量比(GRWR)、手术时间、术中失血量比较差异无统计学意义(均P>0.05)。2组受者的肺感染、急性排斥反应、门静脉吻合口狭窄、门脉血栓、肝动脉闭塞、胆漏、胆肠吻合口狭窄等发生率差异无统计学意义(均P>0.05)。Kasai组肝移植术后总体并发症发生率为61.1%,高于非Kasai组的43.3%(χ~2=4.580,P=0.032)。全部患者中死亡7例(4.7%),其中Kasai组6例(4.0%),5例为多器官功能衰竭,1例严重的肺感染;非Kasai组1例(0.7%),因术前消化道出血急诊手术死于多器官功能衰竭。供者均无严重并发症及死亡。全部受者术后1个月、1年、3年和5年累积生存率分别为98.6%、96.6%、94.9%,92.7%。其中,Kasai组分别为98.9%、96.5%、93.8%、91.3%;非Kasai组分别为98.3%、96.6%、96.4%、95.5%,2组比较差异无统计学意义(χ~2=1.490,P=0.222)。结论胆道闭锁患者在Kasai术后行活体肝移植术可获得满意的临床效果,不会增加移植术后主要并发症的发生率及死亡比例,长期生存率与未接受Kasai手术的患者相当。且Kasai手术可推迟行肝移植的时间、利于儿童生长发育、减轻移植术前黄疸。
Objective To evaluate the effect and prognosis of liver-jejunum anastomosis (Kasai surgery) on liver transplantation in children with biliary atresia. Methods A retrospective analysis was performed on 150 cases of living donor liver transplants from September 2006 to September 2014. 90 of them underwent primary Kasai surgery followed by live donor liver transplantation (Kasai group); 60 received direct Living liver transplantation (non-Kasai group). The general data of two groups of patients were compared, the postoperative complications and the difference of cumulative survival rate. Results Recipient age ranged from 4.9 to 87.0 months. The age, weight and height of transplant recipients in Kasai group were higher than those in non-Kasai group, while the PELD score and preoperative serum bilirubin level were lower in non-Kasai group (all P <0.05) ). There was no significant difference in GRWR, operation time and intraoperative blood loss between the two groups (all P> 0.05). There was no significant difference in incidence of pulmonary infection, acute rejection, portal vein anastomotic stenosis, portal vein thrombosis, hepatic artery occlusion, biliary leakage and cholangioenterostomy stenosis between the two groups (all P> 0.05). The incidence of overall complication after liver transplantation in Kasai group was 61.1%, higher than that in non-Kasai group (χ ~ 2 = 4.580, P = 0.032). Among all the patients, 7 died (4.7%), of which 6 were Kasai (4.0%), 5 were multiple organ failure and 1 was severe pulmonary infection. One patient (0.7%) was non-Kasai group, Road bleeding emergency surgery died of multiple organ failure. None of the donors had serious complications and died. The cumulative survival rates at 1 month, 1 year, 3 years and 5 years after operation were 98.6%, 96.6%, 94.9% and 92.7% respectively. The Kasai group was 98.9%, 96.5%, 93.8% and 91.3% respectively. The non-Kasai group was 98.3%, 96.6%, 96.4% and 95.5% respectively. There was no significant difference between the two groups (χ ~ 2 = 1.490, P = 0.222). Conclusions Patients with biliary atresia undergoing living donor liver transplantation after Kasai may obtain satisfactory clinical results without increasing the incidence of major complications and the proportion of death after transplantation. The long-term survival rate is comparable with those without Kasai surgery. And Kasai surgery can postpone the time of liver transplantation, which will benefit children’s growth and development and reduce preoperative jaundice.