摘要目的 探讨影响胆道闭锁(biliary atresia,BA) Kasai术后预后的相关因素,了解我省BA的治疗现状.方法 回顾性分析2009年1月至2015年12月间,在山西省儿童医院行腹腔镜探查、胆道造影确诊胆道闭锁后行Kasai术且随访资料完整的91例患儿.采用Kaplan-Meier法计算各亚组患儿自体肝存活率.各亚组之间自体肝存活率的比较应用Log-rank检验,多因素分析采用COX回归模型.结果 全组患儿6个月、1年、2年的自体肝存活率分别为76.9％(70/91)、48.3％(44/91)、36.3％(33/91).按手术日龄将患儿分为:＜60 d(34例)、60～90(含60)d(47例)、90～120(含90)d(8例)和≥120 d(2例)组,各组2年累计自体肝存活率分别为55.8％(19/34)、44.7％(21/47)、12.5％(1/8)和0(P=0.047).男、女童2年累计自体肝存活率分别为36.4％(16/44)和46.8％(22/47),差异无统计学意义(P=0.313).有胆管炎发作组(67例)与无胆管炎发作组(24例)的2年累计自体肝存活率分别为31.3％(21/67)和62.5％(15/24)(P=0.011);黄疸消退明显组(61例)和黄疸消退不明显组(30例)的2年累计自体肝存活率分别为50.8％(31/61)和23.3％ (7/30) (P=0.012);肝功能恢复良好组(53例)和肝功能恢复较差组(38例)2年累计自体肝存活率分别为56.6％(30/53)和21.1％(8/38)(P=0.01);Ⅰ型、Ⅱ型、Ⅲ型闭锁的2年累计自体肝存活率分别为77.8％(7/9)、66.7％(4/6)和31.6％(24/76)(P=0.023),差异均有统计学意义.结论 手术日龄、有无胆管炎发作、黄疸消退情况、肝功能恢复情况及胆道闭锁分型为影响Kasai手术预后的影响因素,其中手术日龄、黄疸消退和肝功能恢复情况是影响生存的独立预后因素.提高民众对胆道闭锁的认知水平,加强术后随访评估,对提高胆道闭锁生存率有重要意义.

abstractsObjective To explore the prognostic factors and countermeasures after Kasai operation for biliary atresia (BA) and seek the measures of improving its survival rate.Methods Retrospective analyses were performed for 91 children undergoing Kasai operation.Follow-ups were conducted with complete data from January 2009 to December 2015.The survival rate was estimated by Kaplan-Meier method.And the prognostic factors were analyzed by univariate (log rank) and multivariate (Cox) methods.Results The overall survival rates of 6 months,1 year and 2 years were 76.9 ％ (70/91)、48.3 ％ (44/91) and 36.3 ％ (33/91) respectively.According to operative day (d) age,they were divided into the groups of d＜60、60≤d＜90、90≤d＜120 and d≥120.Their survival rates were 55.8％(19/34)、44.7％(21/47) 、12.5％(1/8) and 0 (P =0.047) respectively;the survival rates of cholangitis attack or not were 31.3％(21/67) and 62.5％ (15/24) (P =0.011);the survival rates of jaundice subsiding significantly or not were 50.8％ (31/61) and 23.3％ (7/30) (P =0.012);the survival rates of liver function recovery were 56.6％ (30/53) and 21.1％ (8/38) (P =0.01);The survival rates of various BA types were 77.8％ (7/9),66.7％ (4/6) and 31.6％ (24/76) respectively (P =0.023).Conclusions Operative age,cholangitis attack,jaundice subsiding,liver function recovery and type of BA are statistically significant for the prognosis of Kasai operation.And operative age,jaundice subsiding and liver function recovery are independent prognostic factors.Boosting the level of public perception of BA and strengthening postoperative follow-ups are essential for improving the survival rate of BA.