【摘要】 目的 对比胆道闭锁患儿接受Kasai-肝移植（liver transplantation,LT）序贯治疗和一期直接行LT治疗的效果。方法 回顾性收集四川大学华西医院小儿外科2018年1月至2025年1月期间收治的符合纳入和排除标准的胆道闭锁行LT治疗的患儿，根据治疗方案分为Kasai-LT序贯治疗组（简称“Kasai-LT组”）和一期直接LT治疗组（简称“一期LT组”），比较2组患儿的人口学资料、一般临床资料、术中情况、术后恢复情况、并发症和生存情况。结果 共纳入300例患儿，其中Kasai-LT组225例、一期LT组75例。经倾向性评分匹配后，Kasai-LT组150例，一期LT组75例。手术相关指标比较显示，Kasai-LT组手术时间（P=0.005）、儿童重症监护病房停留时间（P=0.026）及总住院时间（P=0.015）均更短，住院费用更低（P=0.017）。术后第7天，2组患儿肝功能恢复情况比较差异无统计学意义（P>0.05）。与一期LT组相比，Kasai-LT组肝动脉并发症及胸腹部感染发生率更低（P=0.023、P=0.003）。Kasai-LT组和一期LT组患儿5年累积生存率分别为94.40%和88.10%，移植物5年累积存活率分别为89.30%和86.80%，差异均无统计学意义（P>0.05）。结论 胆道闭锁Kasai手术可有效改善肝移植条件，降低肝移植术后并发症发生率。胆道闭锁的治疗可选择Kasai-LT序贯疗法并结合个体化治疗方案。更多还原

【Abstract】 Objective To compare the efficacy of two regimens of biliary atresia treated with Kasai-liver transplantation(LT) sequential therapy and direct primary LT. Methods A retrospective study was conducted on pediatric patients diagnosed with biliary atresia who underwent LT and met the inclusion and exclusion criteria at the Department of Pediatric Surgery, West China Hospital, Sichuan University, from January 2018 to January 2025. The enrolled children were divided into two groups according to treatment regimens: the Kasai-LT group and the direct primary LT group. Demographic data, general clinical data, intraoperative conditions, postoperative recovery,complications, and survival rates were compared between the two groups. Results A total of 300 pediatric patients were enrolled, including 225 in the Kasai-LT group and 75 in the primary LT group. After propensity score matching, there were 150 patients in the Kasai-LT group and 75 in the primary LT group. In terms of surgical parameters, the Kasai-LT group had a shorter operative time(P=0.005), stay in the pediatric intensive care unit(P=0.026), and total hospital stay(P=0.015), as well as lower hospitalization costs(P=0.017). No significant differences were observed in liver function recovery on postoperative day 7 between the two groups(P>0.05). The Kasai-LT group presented lower incidences of hepatic artery complications and thoracic and abdominal infections compared with the primary LT group(P=0.023 and P=0.003, respectively). The 5-year cumulative survival rates were 94.40% for the Kasai-LT group and 88.10% for the primary LT group, while the 5-year cumulative graft survival rates were 89.30% and 86.80%, respectively. No statistically significant differences were found between the two groups for either indicator(P>0.05). Conclusions Kasai procedure for biliary atresia can effectively improve LT conditions and reduce the rate of postoperative complications. For the treatment of biliary atresia, sequential Kasai procedure combined with LT is a viable option, and individualized therapeutic regimens should also be adopted.更多还原