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目的采用术中门静脉压力测定对胆道闭锁患儿Kasai术后的预后评估。方法1990年1月至1996年12月,法国巴黎Bic毢tre医院儿外科共对127例胆道闭锁患儿行Kasai手术或其变异术式,其中113例术中脐静脉插管行门静脉压力测定,术后平均随访9年。分别计算患儿带自体肝生存率和带自体肝且无门静脉高压生存率,进行比较;依据患儿手术时的年龄,胆道闭锁的类型,手术方式,有无polysplenia综合征以及术时门静脉压力对生存率进行评估。结果术中门脉压力正常患儿带自体肝5年和10年生存率较门静脉压力升高组显著延长。门静脉压力升高组5年带自体肝且无门静脉高压表现的生存率显著低于门静脉压力正常组。胆道闭锁的类型和门静脉压力改变较其他指标更显著反映对Kasai术后预后影响。结论术前门静脉压力改变对Kasai术后的预后有显著性指导意义,并且优于其他指标。
Objective To evaluate the postoperative prognosis of children with biliary atresia by intraoperative portal pressure measurement. Methods From January 1990 to December 1996, 127 pediatric patients with biliary atresia were undergone Kasai surgery or variant surgery in pediatric department of Bichang Hospital, Paris, France. Among them, 113 cases underwent umbilical vein catheterization for portal vein pressure measurement, After an average of 9 years follow-up. According to the age of the children, the type of biliary atresia, the operation method, the presence or absence of polysplenia syndrome, and the time-to-portal pressure of the portal vein, the rates of autologous liver survival and autologous liver with no portal hypertension were calculated. Survival rates were assessed. Results The 5-year and 10-year survival rates of autologous liver in patients with normal portal pressure were significantly longer than those in portal hypertension. The 5-year survival rate of autologous liver without portal hypertension in portal hypertension group was significantly lower than that of normal portal vein pressure group. The type of biliary atresia and changes in portal pressure more than any other index reflect the prognostic impact of Kasai surgery. Conclusions Preoperative portal vein pressure changes have significant guiding significance for the prognosis of Kasai patients and are superior to other indexes.