The impact of a previous Kasai procedure on liver transplantation for biliary atresia
The impact of a previous Kasai procedure on liver transplantation for biliary atresia
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DOI：
10.1016/s0022-3468(97)90594-7
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发表时间：
1997-03-01
影响因子：
2.4
通讯作者：
Superina, RA
中科院分区：
文献类型：
--
作者：
Sandler, AD;Azarow, KS;Superina, RA
胆道闭锁的通常治疗是加塞手术，然后在有指征时进行肝移植。虽然偶尔提倡在没有加塞手术的情况下进行原发性胆道闭锁移植，但很少进行。本综述旨在评价加塞手术对需要肝移植患者的发病率和死亡率的影响。63例胆道闭锁患者纳入本综述。57例患者接受了移植：8例患者仅接受了肝移植（第1组），49例患者在移植前接受了加塞手术（第2组）。6名患者在接受移植前死亡。第2组患者等待肝移植的时间长于第1组患者（170.3 +/-24.6天vs 63.3 +/-7.1天，P <0.05）。与第2组患者相比，第1组患者更年轻（0.7 +/-0.2 vs 2.3 +/-0.4岁）和更小（6.9 +/-0.4 kg vs 11.6 +/-1.2 kg）（P = 0.07）。两组移植前尿急状态无差异。组1患者的移植手术平均持续时间较短（476.8 +/-53.3分钟）与第2组相比（593.9 +/-29.3分钟，P = 0.06），第1组患者术中输血199.8 +/-46.2 mL/kg，第2组患者输血量为两倍，466 +/-122.5 mL/kg。第1组中没有患者发生术后肠穿孔或因出血需要再次手术。然而，在第2组中，49例患者中有11例（22.4%）发生肠穿孔，49例患者中有7例（14.2%）因出血需要再次手术，两组之间的非手术并发症无差异。两组的长期生存率相同：第1组8例患者中有6例（75%），第2组49例患者中有36例（74%）。第2组患者中观察到的并发症显著增加未达到统计学显著性，因为第1组的患者数量少得多。这些结果表明，如果在移植前不进行加塞手术，胆道闭锁患者移植后并发症较少，并且需要更仔细地选择治疗胆道闭锁患者的手术方案。版权所有（C）1997 W.B.桑德斯公司
The usual treatment for biliary atresia is a Kasai procedure followed by liver transplantation when indicated. Although primary transplantation for biliary atresia without a previous Kasai procedure is occasionally advocated, it is rarely performed. This review was undertaken to evaluate the impact of a Kasai procedure on the morbidity and mortality of patients who went on to need a liver transplant, Sixty-three patients with biliary atresia were included in this review. Fifty seven patients underwent transplantation: eight patients had a liver transplant only (group 1), and 49 patients underwent a Kasai procedure before transplantation (group 2). Six patients died before receiving a transplant. Time spent on the waiting list for liver transplant was longer in group 2 than in group 1 (170.3 +/- 24.6 days versus 63.3 +/- 7.1 days, P < .05). The patients in group 1 were younger (0.7 +/- 0.2 versus 2.3 +/- 0.4 years) and smaller (6.9 +/- 0.4 kg versus 11.6 +/- 1.2 kg) than the patients in group 2 (P = .07). There was no difference in pretransplant urgency status between the two groups. The mean duration of the transplant operation was shorter in group 1 patients (476.8 +/- 53.3 minutes) compared with group 2 (593.9 +/- 29.3 minutes, P = .06), Group 1 patients received 199.8 +/- 46.2 mL/kg blood transfusion intraoperatively, and group 2 patients had twice that amount, 466 +/- 122.5 mL/kg. No patients in group 1 experienced postoperative bowel perforations or required reoperation for bleeding. In group 2 however, 11 of 49 (22.4%) experienced bowel perforations and 7 of 49 (14.2%) required reoperation for bleeding, There was no difference in nonsurgical complications between the two groups. Long-term survival was equal in the 2 groups: six of eight patients (75%) in group 1 and 36 of 49 (74%) in group 2. The marked increase in complications noted in group 2 patients did not reach statistical significance because of the much smaller number of patients in group 1. These results suggest that patients with biliary atresia have fewer complications after transplantation if a Kasai procedure is not performed before the transplant, and that a more careful selection of surgical options available in treating patients with biliary atresia is required. Copyright (C) 1997 by W.B. Saunders Company.