Home intravenous antibiotic treatment for intractable cholangitis in patients with biliary atresia following Kasai portoenterostomies.
Home intravenous antibiotic treatment for intractable cholangitis in patients with biliary atresia following Kasai portoenterostomies.
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DOI：
10.4174/jkss.2011.80.5.355
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发表时间：
2011-05
影响因子：
--
通讯作者：
Han SJ
中科院分区：
文献类型：
--
作者：
Shin JH;Chang EY;Chang HK;Kim SM;Han SJ
采用 Kasai 门肠造口术治疗的胆道闭锁 (BA) 患者随后可能会发展为对常规保守治疗无反应的顽固性胆管炎 (IC)。它可能导致胆汁性肝硬化，并最终导致肝功能衰竭并伴有门静脉高压。控制 IC 需要长期住院以静脉注射抗生素。为了缩短住院时间，我们设计了一种家庭静脉抗生素治疗（HIVA），可以在初次住院治疗后进行。在这项研究中，我们回顾了这种治疗的效果。我们回顾了 1997 年 7 月至 2009 年 6 月期间成功进行 Kasai 门肠造口术治疗 BA 后接受 HIVA 治疗的 10 名患者的医疗记录。HIVA 持续时间为 8 至 39 个月（中位时间为 13.5 个月）。 HIVA 前控制 IC 的常规治疗的平均住院时间为每月 5.7 天，HIVA 后为每月 1.5 天（P = 0.012）。艾滋病毒感染者每月的医疗费用中位数减少了约十分之一。一名患者因食管静脉曲张出血不受控制而接受肝移植，但其他九名患者的自体肝脏肝功能尚可。 HIVA 可能是继 Kasai 门肠造口术治疗 BA 后 IC 的有效主要治疗方法，并可减少住院时间和医疗费用。
Patients with biliary atresia (BA) treated with Kasai portoenterostomy may later develop intractable cholangitis (IC) that is unresponsive to routine conservative treatment. It may cause biliary cirrhosis and eventually hepatic failure with portal hypertension. Control of IC requires prolonged hospitalization for the administration of intravenous antibiotics. To reduce the hospitalization period, we designed a home intravenous antibiotic treatment (HIVA) which can be administered after initial inpatient treatment. In this study, we reviewed the effects of this treatment. We reviewed medical records of 10 patients treated with HIVA for IC after successful Kasai portoenterostomies performed for BA between July 1997 and June 2009. The duration of HIVA ranged from 8 to 39 months (median, 13.5 months). The median length of hospital stay was 5.7 days per month for conventional treatments to manage IC before HIVA and, 1.5 days per month (P = 0.012) after HIVA. The median amount of medical expenses per month was reduced by about one tenth with HIVA. One patient underwent liver transplantation due to uncontrolled esophageal variceal bleeding, but the other nine patients had acceptable hepatic function with native livers. HIVA may be an effective primary treatment for IC after Kasai portoenterostomies for BA, and reduce length of hospital stay and medical expense.