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首页> 外文期刊>Pediatric surgery international >Experience of treating biliary atresia with three types of portoenterostomy at a single institution: Extended, modified Kasai, and laparoscopic modified Kasai
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Experience of treating biliary atresia with three types of portoenterostomy at a single institution: Extended, modified Kasai, and laparoscopic modified Kasai

机译：在单一机构使用三种类型的门肠造口术治疗胆道闭锁的经验：扩展，改良型开赛和腹腔镜改良型开赛

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Purpose: Generally, open portoenterostomy (PE) involves a wide extended anastomosis and all sutures are deep [extended PE (EP)]. In contrast, the anastomosis in Kasai's PE (KP), our modified open Kasai PE (MK), and our laparoscopic modified Kasai PE (lapMK) involve shallow suturing, especially at the 2 and 10 o'clock positions where the right and left bile ducts would be normally. We compared outcomes of 36 consecutive biliary atresia (BA) patients treated by three types of PE at a single institution during the period 2005-2014; EP (n = 13), MK (n = 11), and lapMK (n = 12). Methods: We compared age at PE, time taken to become jaundice-free (total bilirubin ≤1.2 mg/dL; JF time), proportion of JF subjects [JF ratio (JFR)], steroid dosage, incidence of cholangitis, postoperative liver function and CRP, presence of hypersplenism, requirement for liver transplantation (LTx), and JF survival with the native liver (JF+NL) as indicators of outcome. Results: Patient demographics, steroid dosage, JF time, incidence of cholangitis, presence of hypersplenism, operating time, blood loss and postoperative biochemistry were similar for all groups. However, JFR was significantly higher for lapMK (100 %) versus EP (46.2 %) (p < 0.05), but not for MK (81.8 %) versus EP. Kaplan-Meier analysis showed survival with NL was significantly higher for lapMK (10/12: 83.3 %: JF in 9; not JF in 1) and MK (9/11: 81.8 %: JF in all) versus EP (3/13: 23.1 %: JF in all) (p < 0.05, respectively), but not for lapMK versus MK. JF+NL in both lapMK (9/12: 75.0 %) and MK (9/11: 81.8 %) were significantly higher compared with EP (3/13: 23.1 %) (p < 0.05, respectively). Intraperitoneal adhesions were less pronounced at LTx in lapMK compared with MK or EP. Conclusions: This study would suggest that depth of suturing during PE would appear to influence post-PE outcome. LapMK should be reconsidered as a valid treatment option for BA.
机译：目的：通常，开放性门肠吻合术（PE）涉及广泛的扩展吻合术，所有缝合线均较深[扩展PE（EP）]。相反，Kasai PE（KP），我们改良的开放式Kasai PE（MK）和我们的腹腔镜改良Kasai PE（lapMK）的吻合涉及浅缝合，尤其是在左右胆汁的2点和10点位置管道正常。我们比较了2005年至2014年期间在同一家机构中接受三种类型的PE治疗的36例连续性胆道闭锁（BA）患者的结局; EP（n = 13），MK（n = 11）和lapMK（n = 12）。方法：我们比较了PE的年龄，无黄疸的时间（总胆红素≤1.2mg / dL; JF时间），JF受试者的比例[JF比（JFR）]，类固醇剂量，胆管炎的发生率，术后肝功能CRP，脾功能亢进，肝移植需求（LTx）以及以天然肝（JF + NL）作为结局指标的JF生存率。结果：所有组的患者人口统计学，类固醇剂量，JF时间，胆管炎发生率，脾功能亢进，手术时间，失血量和术后生化指标均相似。但是，lapMK（100％）相对于EP（46.2％）的JFR明显更高（p <0.05），而MK（81.8％）相对于EP则没有。 Kaplan-Meier分析显示，lapMK（10/12：83.3％：JF在9中;不是JF在1中）和MK（9/11：81.8％：在所有JF中）的NL生存率均显着高于EP（3/13 ：23.1％：所有JF）（分别为p <0.05），但lapMK和MK则不然。 lapMK（9/12：75.0％）和MK（9/11：81.8％）的JF + NL均显着高于EP（3/13：23.1％）（分别为p <0.05）。与MK或EP相比，lapMK的LTx腹膜内粘连不明显。结论：这项研究表明，在体育锻炼期间缝合的深度似乎会影响体育锻炼后的结局。应该将LapMK重新视为BA的有效治疗选择。

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