Postoperative corticosteroid therapy for bile drainage in biliary atresia - A nationwide survey
Postoperative corticosteroid therapy for bile drainage in biliary atresia - A nationwide survey
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DOI：
10.1016/j.jpedsurg.2004.08.019
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发表时间：
2004-12-01
影响因子：
2.4
通讯作者：
Ohi, R
中科院分区：
文献类型：
--
作者：
Muraji, T;Nio, M;Ohi, R
目的：对日本胆道闭锁学会的成员进行调查，以确定他们目前在Kasai手术后早期使用皮质类固醇的做法。方法：问题包括患者的背景资料、剂量、时间、并发症和结果。采用Kaplan-Meier分析，对按类固醇剂量分组的两组无黄疸生存率进行统计学比较。结果：在所调查的54家机构中，从34名应答者中共收集到222例不可纠正性BA患者，其中接受类固醇治疗的患者208例，未接受类固醇治疗的患者14例。31%的患者在术后第一周开始使用强的松龙，64%的患者在术后第二周使用强的松龙。1例患者术后第1天给予强的松龙3mg /kg/d，出现穿孔和腹膜炎。类固醇组和非类固醇组的生存率分别为58.0%和35.7% （P = 0.052）。100例患者初始剂量小于或等于3.9 mg/kg/d， 108例患者大于或等于4.0 mg/kg/d。≥4.0 mg/kg/d组和非类固醇组的生存率分别为58.9%和35.7% （P = 0.0494）。结论：(1)大多数外科医生使用类固醇。(2)虽然类固醇组无黄疸生存率较高，但非类固醇组患者数量太少，无法得出结论。(3)推荐初始类固醇剂量大于或等于4.0 mg/kg/d。(4)如果不过早给药，并发症是罕见的。(C) 2004爱思唯尔公司版权所有。
Purpose: Members of the Japanese Biliary Atresia Society were surveyed to determine their current practice regarding early use of corticosteroids after Kasai's operation.Methods: Questions included the patient's background data, dosage, timing, complications, and outcome. Anicteric survival with the native liver was statistically compared between groups categorized by steroid dosage using Kaplan-Meier analysis.Results: Among 54 institutions surveyed, a total of 222 patients with uncorrectable BA were collected from 34 responders, including 208 patients who received steroid therapy and 14 without it. Prednisolone was started during the first Postoperative week in 31% and during the second week in 64%. Perforation and peritonitis occurred in 1 patient given 3 mg/kg/d of prednisolone on postoperative day 1. The survival rates of the steroid and nonsteroid groups were 58.0% and 35.7%, respectively (P = .052). The initial dose of prednisolone was less than or equal to3.9 mg/kg/d in 100 patients and greater than or equal to4.0 mg/kg/d in 108 patients. The survival rates of the group receiving greater than or equal to4.0 mg/kg/d and the nonsteroid group were 58.9% and 35.7%, respectively (P = .0494).Conclusions: (1) Most surgeons use steroids. (2) Although the anicteric survival rate was higher in the steroid group, the number of patients in the nonsteroid group was too small to draw conclusions. (3) The recommended initial steroid dose is greater than or equal to4.0 mg/kg/d. (4) Complications are uncommon if administration is not started too early. (C) 2004 Elsevier Inc. All rights reserved.