胆道闭锁Kasai手术日龄与早期预后的关联性分析.

Objective To explore the correlation between age of Kasai portoenterostomy and early prognosis to provide references for timing of Kasai surgery in biliary atresia (BA) children. Methods Retrospective review was conducted for clinical data of hospitalized BA children from January 2019 to December 2021.General profiles (gender & operative age) and parameters of liver function, coagulation function and blood ammonia were collected. According to the jaundice clearance at 3 months post-operation, they were assigned into two groups of non-jaundice clearance (n=47) and jaundice clearance (n=66).The cut-off value of operative age was calculated. Then two groups were divided according to operative age. The prognostic parameters of Kasai portoenterostomy at 3 months post-operation were compared, including alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), direct bilirubin (DBIL), postoperative DBIL/ preoperative DBIL, gamma-glutamyltransferase (GGT), total bile acid (TBA), total bilirubin (TBIL), platelet count (PLT), aspartate aminotransferase-to-platelet ratio index (APRI) and international normalized ratio (INR). Results A total of 113 cases were collected, including 49 males and 64 females. The operative age was 59.00 (40.50, 69.00) days. Univariate analysis of the preoperative indexes of the non-jaundice clearance group and the jaundice clearance group showed that the age of operation(64 (52, 79) d vs. 55 (33, 67) d), AST (202.00 (138.00, 332.00) U/L vs. 147.50 (100.00, 242.00) U/L), indirect bilirubin (IBIL) ((70.60±20.31)μmol/L vs. (79.96±27.13)μmol/L), total protein(TP) ((55.88±6.59)g/L vs. (53.13±4.71)g/L) between the two groups were statistically significant (P < 0.05). The indexes with P < 0.1 in univariate analysis [age of operation, albumin (ALB), ALT, AST, IBIL, TP, activated partial thromboplastin time(APTT)] were included in the multivariate Logistic regression analysis, and the results showed that the age of operation (OR=0.974, 95%CI: 0.951-0.997, P=0.030) was an independent factor influencing the jnundice clearance at 3 months after Kasai protoentrostomy. According to the cut-off value (46.5d) of the operative age group, the results showed that the levels of ALP(365.00 (316.00, 514.75) U/L vs. 492.00 (343.00, 684.00) U/L), ALT ((76.35±81.33) U/L vs. (134.09±97.45)U/L), AST (67.50 (41.50, 99.50) U/L vs. 112.00 (79.00, 168.00) U/L), DBIL (2.55 (1.78, 6.95) μmol/L vs. 9.80 (3.60, 36.80) μmol/L), postoperative DBIL/ preoperative DBIL(0.05 (0.03, 0.09) vs. 0.12 (0.05, 0.54)), TBA (45.50 (25.93, 92.93) μmol/L vs.106.20 (41.20, 187.50) μmol/L), TBIL (9.65 (6.98, 15.43) μmol/L vs. 21.50 (10.40, 66.90) μmol/L) and APRI (0.32 (0.22, 0.48) vs.0.62 (0.41, 0.93)) in the operation age ≤46.5 d group were significantly lower than those in the operation age > 46.5 d group, the difference was statistically significant (P < 0.05). Conclusion Early prognostic parameters are superior in group with operative age≤46.5 days to group with operative age >46.5 days. And early Kasai portoenterostomy may improve the prognosis of BA. [ABSTRACT FROM AUTHOR]