胆道闭锁患儿Kasai手术后频发胆管炎的危险因素及预后分析.

Objective To explore the risk factors and outcomes of recurrent cholangitis after Kasai in biliary atresia (BA) patients. Methods Retrospective review was conducted for clinical and follow-up data of 60 BA children with cholangitis after Kasai procedure from January 2018 to September 2021.According to whether the frequency of cholangitis episodes was more than or equal to 3 times in half a year, they were divided into two groups of recurrent cholangitis (n=20) and occasional cholangitis (n=40).Gender, preoperative body mass index (BMI), cytomegalovirus (CMV) infection, age at Kasai surgery, liver fibrosis grade, serum levels of liver function parameters at preoperation and Day 14 postoperation and the occurrence of early cholangitis were compared between two groups.Cox regression analysis was performed for estimating the risk factors of recurrent cholangitis.Postoperative jaundice clearance (JC) rate and postoperative native liver survival rate were also compared between two groups. Results No significant differences existed in gender, preoperative BMI, CMV infection, age at Kasai or liver fibrosis grade (P>0.05).Serum total bile acid level at preoperation was significantly lower in recurrent cholangitis group than that in occasional cholangitis group (Z=-2.070, P < 0.05).Alanine transaminase(ALT)[(169.47±93.53)U/L], Aspartate trans aminase(AST)[(173.96±96.25)U/L], [242.50(169.68, 296.13)ratio 244.50(148.50, 297.00)U/L], gamma-glutamyl transferase(GGT)[572.00(310.75, 895.75)than 388.00(245.50, 695.25)U/L], total bilirubin, (219.61±73.08)ratio(207.38±58.63)μmol/L), direct bilirubin(DBIL)ratio(122.70(104.50, 163.25)ratio 116.70(81.42, 158.35)μmol/L]and albumin, Alb[(36.27±2.91)vs.(37.88±4.90)g/L]at preoperation between 2 groups had no significant difference(P>0.05).ALT[(211.23±144.87)to(229.87±104.76)U/L]and AST[162.50(108.17, 225.75)to 196.50(160.75, 235.43)U/L], GGT[(742.85±438.09)vs.(584.05±385.31)U/L], TBIL[136.20(86.05, 190.23)vs.145.50(95.73, 213.90)μmol/L], DBIL[79.85(60.88, 122.83)vs.90.00(61.30, 129.30)μmol/L]and Alb[(37.92±5.55)vs.(39.22±4.55)g/L]at day 14 postoperation between 2 groups were not significantly different(P>0.05).The incidence of early cholangitis was significantly higher in recurrent cholangitis group than that in occasional cholangitis group (χ2=9.909, P < 0.05).Cox regression analysis revealed that early cholangitis was risk factor for recurrent cholangitis; JC rate of recurrent cholangitis group was lower than that of occasional cholangitis group at Month 3/6 postoperation.However, the difference was not statistically significant (P>0.05).JC rate at Month 12 postoperation was significantly lower in recurrent cholangitis group than that in occasional cholangitis group (χ2=5.179, P < 0.05).No significant inter-group difference existed in native liver survival rate at 1 year postoperation (P>0.05). Conclusion Early cholangitis is an independent risk factor for recurrent cholangitis after Kasai in BA children.And recurrent cholangitis affects the postoperative jaundice clearance. [ABSTRACT FROM AUTHOR]