【摘要】 目的 探讨Kasai手术对胆道闭锁(BA)患儿行肝移植术疗效的影响。方法 回顾性分析2013年10月至2020年10月在中山大学附属第三医院岭南医院行肝移植术的105例BA患儿临床资料。患儿监护人均签署知情同意书，符合医学伦理学规定。其中男61例，女44例；年龄4～168个月，中位年龄8个月。根据肝移植术前是否行Kasai手术，分为Kasai组(51例)和非Kasai组(54例)。比较两组肝移植术前一般情况、围手术期情况和术后并发症发生情况。对患儿进行随访，比较两组肝移植术后生存率。两组年龄、儿童终末期肝病模型(PELD)评分、移植物重量与受体体重比(GRWR)比较采用秩和检验或t检验。两组肝移植术后并发症发生率比较采用χ~2检验。生存分析采用Kaplan-Meier法和Log-rank检验。结果 Kasai组移植时年龄为11(28)个月，明显大于非Kasai组的7(2)个月(Z=5.005，P<0.05)；而PELD评分为8(22)分，明显低于非Kasai组的21(10)分(Z=-5.211，P<0.05)；GRWR为(3.0±0.9)%，亦明显低于非Kasai组的(3.4±0.7)%(t=-2.275，P<0.05)。Kasai组24%(12/51)采用全肝移植，非Kasai组94%(51/54)采用活体或劈离式肝移植(χ~2=8.443，P<0.05)。Kasai组肝移植术后并发症发生率为12%(6/51)，非Kasai组为17%(9/54)，差异无统计学意义(χ~2=0.515，P>0.05)。Kasai组肝移植术后1、2、3、5年生存率分别为94.1%、88.7%、83.5%、83.5%，非Kasai组相应为92.6%、90.4%、87.9%、78.1%，差异无统计学意义(χ~2=0.001，P>0.05)。结论 Kasai手术能有效延迟BA患儿肝移植需求，改善术前条件，降低肝移植手术风险和难度，且与直接行肝移植患儿术后生存率相当。更多还原

【Abstract】 Objective To evaluate the effect of Kasai operation on the clinical efficacy of liver transplantation in children with biliary atresia (BA).Methods Clinical data of 105 children with BA who underwent liver transplantation in Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University from October 2013 to October 2020 were retrospectively analyzed.The informed consents of the patients’ guardians were obtained and the local ethical committee approval was received.Among them,61 children were male and 44 female,aged from 4 to 168 months old,with a median age of 8 months old.According to whether Kasai operation was performed before liver transplantation,the patients were divided into the Kasai group (n=51) and non-Kasai group (n=54).Preoperative general conditions,perioperative conditions and incidence of postoperative complications were compared between two groups.The children were followed up.The survival rate after liver transplantation was compared between two groups.Age,pediatric end-stage liver disease (PELD) score and the graft-to-recipient weight ratio (GRWR) between two groups were compared by rank-sum test or t test.The incidence of complications after liver transplantation between two groups was compared by Chi-square test.Survival analysis was performed by Kaplan-Meier method and Log-rank test.Results In the Kasai group,the age of children undergoing liver transplantation was 11(28) months,significantly older than 7(2) months in the non-Kasai group (Z=5.005,P<0.05).In the Kasai group,the PELD score was 8(22),significantly lower compared with 21(10) in the non-Kasai group (Z=-5.211,P<0.05).In the Kasai group,the GRWR was (3.0±0.9)%,significantly lower than (3.4±0.7)% in the non-Kasai group (t=-2.275,P<0.05).Total liver transplantation was adopted in 24%(12/51) of patients in the Kasai group,whereas living or split liver transplantation was performed in 94%(51/54) of patients in the non-Kasai group (χ~2=8.443,P<0.05).The incidence of complications after liver transplantation in the Kasai group was 12%(6/51) and 17%(9/54) in the non-Kasai group with no significant difference between two groups (χ~2=0.515,P>0.05).In the Kasai group,the 1-,2-,3-and 5-year survival rates after liver transplantation were 94.1%,88.7%,83.5% and 83.5%,and 92.6%,90.4%,87.9% and 78.1% in the non-Kasai group with no significant difference between two groups (χ~2=0.001,P>0.05).Conclusions Kasai operation can effectively postpone the requirement of liver transplantation in BA children,improve the preoperative conditions,lower the risk and difficulty of liver transplantation,and yield equivalent survival rate compared with that of their counterparts undergoing immediate liver transplantation.更多还原