Laparoscopic Kasai portoenterostomy is advantageous over open Kasai portoenterostomy in subsequent liver transplantation
Laparoscopic Kasai portoenterostomy is advantageous over open Kasai portoenterostomy in subsequent liver transplantation
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DOI：
10.1007/s00464-019-07108-y
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发表时间：
2020-08-01
影响因子：
3.1
通讯作者：
Uchida, Hiroo
中科院分区：
文献类型：
--
作者：
Shirota, Chiyoe;Murase, Naruhiko;Uchida, Hiroo
背景：胆道闭锁(BA)的腹腔镜Kasai门肠吻合术(Lap-PE)后的自然肝存活率存在争议。我们研究了传统的Kasai门肠吻合术(Open-PE)和Lap-PE的无黄疸自然肝存活率是否具有可比性。然后，这两种类型的PE对随后的活体供肝移植(LTX)的影响在本研究中被讨论。方法对2006年1月至2017年12月接受Open-PE和Lap-PE治疗的1岁和2岁患儿的无黄疸发生率进行调查。此外，对2006-2017年间在Open-PE或Lap-PE后接受LTX的2岁及以下患者的围手术期数据(从开始手术到完成肝切除等)进行了评估。结果46例Open-PE患者中有31例(67%)和30例LAP-PE患者中有23例(77%)在1岁时有自然肝存活(p=0.384)，而在2岁时有29例(63%)Open-PE患者和19例(70%)LAP-PE患者在2岁时有自然肝存活(p=0.524)，差异无统计学意义。出生后2年内发生LTX 37例，其中Open-PE 29例，LAP-PE 8例。与Open-PE组相比，Lap-PE组的患者粘连较少，直到受体完成肝切除术的手术时间和LTX后住院时间显著缩短。Lap-PE组和Open-PE组在出血量或在重症监护病房的住院时间方面没有差异。结论Open-PE组和Lap-PE组无黄褐性肝存活率相当。与Open-PE相比，LAP-PE导致较少的粘连，有助于后续LTX的更好结果。
Background Native liver survival after laparoscopic Kasai portoenterostomy (Lap-PE) for biliary atresia (BA) is controversial. We examined whether a jaundice-free native liver survival rate is comparable between conventional Kasai portoenterostomy (Open-PE) and Lap-PE. Then, the impact of the two types of PE on subsequent living-donor liver transplantation (LTx) was addressed in this study. Methods The jaundice-free rate in 1- and 2-year-old patients who underwent Open-PE and Lap-PE from January 2006 to December 2017 was investigated. Additionally, perioperative data (duration from the start of surgery to the completion of hepatectomy and others) of patients aged 2 years or younger who underwent LTx after either Open-PE or Lap-PE from 2006 to 2017 were evaluated. Results Thirty-one (67%) out of 46 Open-PE patients and 23 (77%) out of 30 Lap-PE patients showed native liver survival with jaundice-free status at 1 year of age (p = 0.384); 29 (63%) out of 46 Open-PE patients and 19 (70%) out of 27 Lap-PE patients showed native liver survival with jaundice-free status at 2 years of age (p = 0.524); there were no significant differences. Additionally, there were 37 LTx cases after PE within 2 years of birth, including 29 Open-PE and 8 Lap-PE cases. The patients in the Lap-PE group had fewer adhesions and significantly shorter durations of surgery up to the completion of the recipient's hepatectomy and durations of post-LTx hospital stay compared to the Open-PE group. There were no differences in blood loss or duration of stay in intensive care unit between the Lap-PE and Open-PE groups. Conclusions Jaundice-free native liver survival rate has been comparable between Open-PE and Lap-PE. Lap-PE resulted in fewer adhesions, contributing to better outcomes of subsequent LTx compared to Open-PE.