To compare the different hepatic portal exposure techniques in Kasai surgery during their different perioperative periods
10.3760/cma.j.cn113884-20221211-00459
- VernacularTitle:胆道闭锁患儿Kasai术中不同肝门暴露技术围手术期对比
- Author:
Ke XU
1
;
Yifan FANG
;
Mingkun LIU
;
Yu LIN
;
Yuanbin HE
;
Xiaoyi CHEN
;
Dianming WU
Author Information
1. 福建省儿童医院(上海儿童医学中心福建医院) 福建医科大学妇儿临床医学院普外科，福州 350011
- Keywords:
Biliary atresia;
Portoenterostomy, hepatic;
Perioperative period;
Exposure of the hepatic portal
- From:
Chinese Journal of Hepatobiliary Surgery
2023;29(3):181-184
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the impact of different portal exposure techniques in the Kasai surgery on children with type Ⅲ. biliary atresia during their different perioperative periods.Methods:A retrospective study was performed on the data of children with type Ⅲ. biliary atresia who underwent Kasai surgery at Fujian Children's Hospital from January 2017 to October 2020. Of 45 children enrolled in this study, there were 24 males and 21 females, aged (71.3±21.0) days. Patients who had left and right branches of the portal vein and the left and right hepatic arteries in the portal area being completely freed and elastically stretched during the Kasai operation were included into the free group ( n=22) and the remaining patients were included in the control group ( n=23). Postoperative hospital stay, postoperative direct bilirubin levels, postoperative complications and transplant-free survival after the Kasai operation were compared between the 2 groups. Results:Postoperative hospital stay of (17.1±4.4) d in the free group was significantly lower than that in the control group (20.1±5.4) d, ( t=2.07, P=0.044). The direct bilirubin level at 3 months after surgery for the control group was 30.0 (109, 108.0)μmol/L, which was significantly higher than that of 14.5 (4.0, 37.5) μmol/L in the free group ( Z=-2.16, P=0.031). Twenty-one patients (91.3%) in the control group had frequent attacks of postoperative cholangitis, compared with 13 patients (59.1%) in the free group. The difference was statistically significant (χ 2=4.69, P=0.030). Eleven surviving patients (47.8%) in the control group did not undergo liver transplantation at one year after surgery, compared with 15 patients (68.2%) in the free group. At two years after surgery, 7 surviving patients (30.4%) in the control group did not undergo liver transplantation compared with 10 patients (45.5%) in the free group. Conclusion:For children with type Ⅲ. biliary atresia, completely freeing the left and right branches of portal vein, and left and right hepatic arteries in the liver portal area, and elastically stretching these vessels to expose the portal area of the liver during Kasai surgery increased surgical safety and reduced hospital stay.
