期刊文献+

胆道闭锁术后早期胆管炎风险因素分析 预览 被引量:11

Risk Factors of Postoperative Early Cholangitis in Biliary Atresia
在线阅读 免费下载
收藏 分享 导出
摘要 目的 探讨影响胆道闭锁术后早期胆管炎发作的风险因素. 方法 对本院2007年1月至2011年12月收治胆道闭锁患儿临床资料进行回顾性分析.所有患儿均采用统一治疗方案,包括手术方式为标准Kasai手术或肝管空肠吻合术,术中胆支引流肠襻45 cm,术后使用激素、抗菌素和利胆药物.将病例以手术年龄、术后黄疸清除效果、Ohi分型和肝纤维化病理分级进行分组,分析影响早期胆管炎发作的原因. 结果 共有139例BA患儿进行手术,124例获得随访.术后35例早期胆管炎发作,发生率为28.3%.术后黄疸完全清除率早期胆管炎发作组低于未发作组(28.2%∶71.8%,P=0.004),术后1年、2年自体肝生存率早期胆管炎发作组低于未发作组(分别为44.5%±8.5%∶86.5%±3.6%,44.5%±8.5%∶76.3%±4.5%,P=0.003).Logistic分析显示黄疸清除速度(P=0.000),肝纤维化病理分级(P =0.029)和Ohi分型基本型(P =0.042)影响早期胆管炎发作而与手术年龄(P=0.579),Ohi分型亚型(P=0.511)和肝外胆管详细分型(P =0.224)无关.结论 良好的肝门部病变类型,术后较好的胆汁引流和较轻的肝纤维化有利于减少胆道闭锁术后早期胆管炎的发生. Objetive To explore the risk factors of early postoperative cholangitis occurring in children's biliary atresia(BA).Methods From January 2007 to December 2011,clinical data of BA in our unit were retrospectively analyzed.All the cases were used with the same protocol including surgery in standard Kasai procedure or hepaticoenterostomy with 45cm's length of Roue-loop,postoperative use of steroid,antibiotics and choleretic drugs.The cases were divided into groups according to age at surgery,the evaluation of postoperative biliary drainage,liver fibrosis and Ohi type (basic type,subtype and bile duct with detail type).Results There were 139 cases of BA with surgery and 124 cases had a completely follow-up.There were 35 cases with onset of early cholangitis,the onset rate was 28.3%.Compared with the cases without onset of early cholangitis,cases with onset have lower ratio of jaundice free of post-operation (28.2% vs 71.8%,P =0.004) and lower 1,2 year's survival rate with native liver (44.5 ± 8.5% vs 86.5-± 3.6%,44.5 vs 8.5% vs 76.3 ± 4.5%,respectively,P =0.003).The logistic regression showed the evaluation of biliary drainage (P =0.000),liver fibrosis (P =0.029) and Ohi basic type (P =0.042) not age at surgery (P =0.579),Ohi subtype (P =0.511) and detailed type of bile duct (P =0.25) were correlated to the onset of early cholangitis.Conclusion In BA,better type of anatomic pattern and biliary drainage after surgery,slighter liver fibrosis help to reduce the risk of early cholangitis occurred.
作者 董淳强 杨体泉 董昆 DONG Chun-qiang,YANG Ti-quan,DONG Kun( 1.Department of Pediatric Surgery The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China;)
出处 《临床小儿外科杂志》 2013年第5期348-353,共6页 Journal of Clinical Pediatric Surgery
基金 本课题为广西省卫生厅计划课题资助,合同号:桂卫Z2011331.
关键词 胆道闭锁 外科手术 胆管炎 Biliary Atresia Surgical Procedures Operative Cholangitis
作者简介 E-mail:dongchunqiang@163.com, 通讯作者:董昆,E-mail:18305623@qq.com
  • 相关文献

参考文献26

  • 1Lin YC, Chang MH, Liao SF, et al. Decreasing rate of bili- ary atresia in Taiwan: a survey, 2004-2009 [ J ]. Pediatrics, 2011,128(3) :e530-536. 被引量:1
  • 2Pakarinen MP, Rintala RJ. Surgery of biliary atresia[J]. Scand J Surg, 2011,100( 1 ) :49-53. 被引量:1
  • 3Superina R, Magee JC, Brandt ML, et al. The anatomic pat- tern of biliary atresia identified at time of Kasai hepatopor- toenterostomy and early postoperative clearance of jaundice are significant predictors of transplant-free survival [ J ]. Ann Surg,2011,254 ( 4 ) :577 -585. 被引量:1
  • 4Roy P, Chatterjee U, Ganguli M, et al. A histopathological study of liver and biliary remnants with clinical outcome in cases of extrahepatic biliary atresia[J]. Indian J Pathol Mi- crobiol, 2010,53( 1 ) : 101-105. 被引量:1
  • 5Jimenez-Rivera C, Jolin-Dahel KS, Fortinsky K J, et al. Inter- national incidence and outcomes of biliary atresia[ J]. J Ped- iatr Gastroenterol Nutr, 2013,56(4) :344-354. 被引量:1
  • 6Tiao MM, Chuang JH, Huang LT, et al. Management of bil- iary atresia: experience in a single institute[ J ]. Chang Gung Med J. 2007.30(2) :122-127. 被引量:1
  • 7宋再,钟微,余家康,陈淑芸,陈兰萍,汪健,郑珊.胆道闭锁多中心综合诊断治疗方案研究[J].中华小儿外科杂志,2011,32(2):81-85. 被引量:21
  • 8Ohi R, Chiba T, Endo N. Morphologic studies of the liver and bile ducts in biliary atresia [ J ]. Acta Paediatr Jpn, 1987,29(4) :584-589. 被引量:1
  • 9曾民德,王泰龄,等.肝纤维化诊断及疗效评估共识[J].中华肝脏病杂志,2002,10(5):327-328. 被引量:528
  • 10Luo Y,Zheng S. Current concept about postoperative cholan- gitis in biliary atresia[ J ]. World J Pediatr,2008,4( 1 ) ..14- 19. 被引量:1

二级参考文献18

  • 1罗义(综述),郑珊(审校).胆道闭锁术后胆管炎诊治的现代概念[J].临床小儿外科杂志,2006,5(2):113-116. 被引量:11
  • 2王玮,郑珊,沈淳,肖现民.胆道闭锁术后大剂量类固醇的疗效及安全性[J].中华小儿外科杂志,2006,27(9):460-463. 被引量:17
  • 3Shneider BL,Brown MB,Haber B,et al.A multicenter study of the outcome of biliary atresia in the United States,1997 to 2000.J Pediatr,2006,148(4):467-474. 被引量:1
  • 4Kanegawa K,Akasaka Y,Kitamura E,et al.Sonographic diagnosis of biliary atresia in pediatric patients using the "triangular cord" sign versus gallbladder length and contraction.Am J Roentgenol,2003,181(5):1387-1390. 被引量:1
  • 5Sevilla A,Howman-Giles R,Saleh H,et al.Hepatobiliary scintigraphy with SPECT in infancy.Clin Nucl Med,2007,32 (1):16-23. 被引量:1
  • 6Chardot C,Carton M,Spire-Bendelac N,et al.Prognosis of biliary atresia in the era of liver transplantation:French national study from 1986-1996.Hepatology,1999,30 (3):606-611. 被引量:1
  • 7Sokol RJ,Mack C,Narkewicz MR,et al.Pathogenesis and outcome of biliary atresia:current concepts.J Pediatr Gastroenterol Nutr,2003,37 (1):4-21. 被引量:1
  • 8Ernest van Heurn LW,Saing H,Tam PKH.Portoenterostomy for biliary atresia:long-term survival and prognosis after esophageal variceal bleeding.J Pediatr Surg,2004,39(1):6-9. 被引量:1
  • 9Karrer FM,PriceMR,Bensard DD,et al.Long-term results with the Kasai operation for biliary atresia.Arch Surg,1996,131 (5):493-496. 被引量:1
  • 10Dillon PW,Owings E,Cilley R,et al.Immunosupp ression as adjuvant therapy for biliary atresia.J Pediatr Surg,2001,36(1):80-85. 被引量:1

共引文献547

同被引文献181

  • 1李龙 ,付京波 ,余奇志 ,刘刚 ,黄柳明 ,刘宝富 ,雷宇 ,王淑芹 ,贾钧 ,王平 ,孙庆林 ,顾志志 .腹腔镜肝门肠吻合术治疗胆道闭锁的探讨(12例报告)[J].腹腔镜外科杂志,2005,10(4):193-195. 被引量:10
  • 2刘雪来,李龙,张军,侯文英,黄柳明.腹腔镜与开腹行肝门肠吻合术治疗小儿先天性胆道闭锁效果的对比研究[J].中国微创外科杂志,2006,6(10):761-763. 被引量:9
  • 3胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2008:2138. 被引量:105
  • 4Balistreri WF, Grand R, Hoofnagle JH, et al. Biliary atresia : current concepts and research directions. Summary of a symposium [ J ].Hepatology, 1996,23 : 1682-1692. 被引量:1
  • 5Carvalho E, Ivantes CAP, Bezerra JA. Extrahepatic biliary atresia: current concepts and future directions[ J]. J Pediatr (Rio J), 2007,83:105-120. 被引量:1
  • 6Hartley JL, Davenport M, Kelly DA. Biliary atresia[ J ]. Lancet,2009,374 : 1704-1713. 被引量:1
  • 7Pakarinen MP, Rintala RJ. Surgery of biliary atresia[J]. Scand J Surg,2011,100:49-53. 被引量:1
  • 8Serinet MO, Wildhaber BE, Brou6 P, et al. Impact of age at Kasai operation on its results in late childhood and adolescence : a ra- tional basis for biliary atresia screening[ J]. Pediatrics,2009,123:1280-1286. 被引量:1
  • 9Wildhaber BE, Majno P, Mayr J, et al. Biliary atresia: Swiss national study, 1994--2004 [ J ]. J Pediatr Gastroenterol Nutr, 2008,46:299-307. 被引量:1
  • 10Sokol RJ. New North American research network focuses on biliary atresia and neonatal liver disease[J]. J Pediatr Gastrocnterol Nutr,2003,36( 1 ) :1. 被引量:1

引证文献11

二级引证文献34

投稿分析

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部 意见反馈