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目的探讨胆道闭锁Kasai术后大剂量类固醇应用的有效性和安全性。方法回顾分析复旦大学附属儿科医院1997年1月~2003年10月胆道闭锁术后52例患儿药物治疗方法及随访资料,比较地塞米松短期冲击治疗(A组)与大剂量甲基强的松龙长期用药(B组)在自体肝生存率、胆汁清除情况,反流性胆管炎发生率及激素并发症等方面的差异。结果平均(32±3.23)个月的随访期内,患儿自体肝总生存率为71.14%。A组自体肝1年生存率为74.75%,2年生存率为68.52%,B组自体肝1年生存率84.97%,2年生存率为67.97%,两组生存率曲线差异无显著性意义(P>0.05)。两组患儿术后6个月黄疸清除率分别为44.0%(11/25)和74.48%(20/27),差异有显著性意义(P<0.05)。A组术后胆管炎发生率为56.0%(14/25),B组为25.92%(7/27)(P<0.05)。B组中1例患儿术后1个月激素治疗疗程中出现消化道出血。结论较短期冲击治疗相比,大剂量长期使用类固醇(甲基强的松龙)可以改善胆道闭锁患儿的术后近期的胆汁引流,减少胆管炎的发生率,但并不能延长自体肝的生存年限。激素使用过程中的并发症的存在影响着其安全性,尚需进一步观察和评价。
Objective To investigate the efficacy and safety of high-dose steroids after biliary atresia Kasai surgery. Methods Retrospective analysis of 52 cases of pediatric biliary atresia in Fudan University affiliated pediatric hospital from January 1997 to October 2003 after drug treatment and follow-up data were compared dexamethasone short-term impact treatment (A group) and high-dose methyl Long-term use of prednisolone (B group) in the autologous liver survival rate, bile clearance, the incidence of reflux cholangitis and hormone complications and other differences. Results The average autologous liver survival rate was 71.14% in the follow-up period of 32 ± 3.23 months. The 1-year survival rate of autologous liver in group A was 74.75%, and the 2-year survival rate was 68.52%. The 1-year survival rate of autologous liver in group B was 84.97%, and the 2-year survival rate was 67.97%. There was no significant difference in survival rate between the two groups P> 0.05). The clearance rate of jaundice in the two groups was 44.0% (11/25) and 74.48% (20/27) respectively at 6 months after operation, the difference was significant (P <0.05). A group of postoperative cholangitis incidence was 56.0% (14/25), B group was 25.92% (7/27) (P <0.05). One patient in group B had gastrointestinal bleeding during the course of hormone therapy one month after operation. Conclusion Compared with short-term impact therapy, long-term high-dose steroid (methylprednisolone) can improve the recent postoperative biliary drainage and reduce the incidence of cholangitis in children with biliary atresia, but can not prolong the survival of autologous liver Years. The existence of complications during the use of hormones affect its safety, the need for further observation and evaluation.