132例胆道闭锁Kasai术后患儿生存率及影响因素分析

Survival analysis after Kasai procedure in 132 children with biliary atresia

摘要:

目的：探讨影响胆道闭锁（biliary atresia，BA）患儿Kasai术后生存率的因素，为临床治疗方案选择及预后判断提供依据。方法：2007年1月至2014年1月间胆道闭锁行肝门空肠吻合术（Kasai术）且资料完整的患儿共132例，随访至2015年1月。所有数据录入SPSS19.0进行统计分析，运用寿命表法计算生存率，分别采用Kaplan-Meier法及COX比例风险回归模型对132例患者的手术时年龄、巨细胞病毒感染、术中病检肝硬化程度、术后是否应用激素与生存率间关系进行单因素和多因素综合分析。结果：132例患儿存活35例，死亡97例；存活患儿中位随访时间为53.3（12~86.17）个月。BA患儿Kasai 术后1年预计生存率为（32.0±6.0）%，2年及5年预计生存率分别为（26.0±4.0）%及（24.0±4.0）%；术后未应用激素组存活率为18.7%（17/91），应用激素组存活率为43.9%（18/41）；肝硬化组存活率为18.9%（14/74），非肝硬化组存活率为36.2%（21/58），经Log-rank检验，术后应用激素及非肝硬化为影响患儿长期生存的重要因素（P=0.027，P=0.037）；经COX回归分析发现，术后激素应用是影响患儿生存率的重要独立因素（RR=0.602，95%CI=0.377~0.964，P=0.034）。结论：Kasai术为提高胆道闭锁患儿生存率的有效治疗方式。术后合理应用激素治疗可能是提高术后生存率的重要措施之一。

Abstract:

Objective：To analyze the survival rate and the risk factors in patients with biliary atresia（BA） who underwent portoen－terostomy（Kasai） procedure. Methods：Totally 132 patients with biliary atresia who underwent Kasai procedure from Janunary 2007 to Janunary 2014 were recruited to this study. Data including age for Kasai procedure，presence of cirrhosis at the time of operation，use of steroids after operation and CMV infection were input in SPSS 19.0. Survival rates of the patients were calculated by life table. Kaplan-Meier method and COX proportional hazards model were used to analyze the suspected risk factors of survival. Results：During the 7-year follow up，35 survived and 97 were dead among all 132 subjects. The median follow up time of survival patients were 53.3（from 12 to 86.17） months. one-，two- and five-year survival rate were （32.0±6.0）%，（26.0±4.0）% and （24.0±4.0）% respec－tively. The survival rates for use of steroids after Kasai procedure or not were 43.9% vs 18.7%（P=0.027）. While the survival rates of cirrhosis at the time of the Kasai procedure or not were 18.9% vs. 36.2%（P=0.037）. Steroid and cirrhosis were regarded as main af－fecting factors for survival rate according to Kaplan-Meier method. However，only the usage of steroid was the solo independent risk factor for survival rates after Kasai procedure by COX proportional hazards model（RR=0.602，95%CI=0.377 to 0.964，P=0.034）. Conclusion：Kasai procedure is an effective treatment for pa－tients with BA，and proper usage of steroids after Kasai opera－tion seems to be one of the important treatments to elevate the survival rate.