Combined Predictors of Long-Term Outcomes of Kasai Surgery in Infants with Biliary Atresia.

IF 1.3 Q3 PEDIATRICS Pediatric Gastroenterology, Hepatology & Nutrition Pub Date : 2024-07-01 Epub Date: 2024-07-08 DOI:10.5223/pghn.2024.27.4.224

Anna Degtyareva, Medan Isaeva, Elena Tumanova, Elena Filippova, Anna Sugak, Alexander Razumovsky, Nadezhda Kulikova, Marina Albegova, Denis Rebrikov

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Abstract

Purpose: Biliary atresia (BA) is the leading cause of neonatal cholestasis (25-45%). The primary treatment is hepatic portoenterostomy (Kasai procedure), but only 20-40% provide long-term benefits. This study aimed to develop a predictive model for surgical efficacy by comparing preoperative and early postoperative indicators in infants with different outcomes.

Methods: We enrolled 166 infants with BA (93 girls, 73 boys) who underwent the Kasai procedure between September 2002 and December 2021, dividing them into favorable or adverse outcome groups. Over 40 parameters were measured, and the diagnostic significance of the prognostic model was evaluated.

Results: Kasai surgery was efficacious in 69 patients (42%) and non-efficacious in 97 (58%). Our model assesses efficacy by day 14 after surgery, improving on the <34 µmol/L direct bilirubin threshold established for 3-6 months after the procedure. Including the Desmet fibrosis score refined the model.

Conclusion: Blood cholesterol below 5.41 mmol/L, direct bilirubin below 56.3 µmol/L on postoperative days 14±3, and a low Desmet score indicate a high probability of efficacious Kasai surgery in infants with BA.

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胆道闭锁婴儿接受卡萨伊手术长期疗效的综合预测因素

目的：胆道闭锁（BA）是新生儿胆汁淤积症的主要原因（25%-45%）。主要治疗方法是肝门肠管造口术（葛西手术），但只有20%-40%的患者能长期获益。本研究旨在通过比较不同结果婴儿的术前和术后早期指标，建立手术疗效预测模型：我们招募了 166 名在 2002 年 9 月至 2021 年 12 月期间接受 Kasai 手术的 BA 婴儿（93 名女孩，73 名男孩），并将他们分为结果良好组和结果不良组。我们测量了40多个参数，并评估了预后模型的诊断意义：69名患者（42%）接受了开塞手术，97名患者（58%）未接受开塞手术。我们的模型对术后第 14 天的疗效进行了评估，对结论进行了改进：术后第 14±3 天，血胆固醇低于 5.41 mmol/L，直接胆红素低于 56.3 µmol/L，且 Desmet 评分较低，表明 BA 婴儿接受 Kasai 手术的有效概率较高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Gastroenterology, Hepatology & Nutrition PEDIATRICS-

CiteScore

3.90

自引率

0.00%

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期刊介绍： Pediatric Gastroenterology, Hepatology and Nutrition (Pediatr Gastroenterol Hepatol Nutr), an official journal of The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition, is issued bimonthly and published in English. The aim of Pediatr Gastroenterol Hepatol Nutr is to advance scientific knowledge and promote child healthcare by publishing high-quality empirical and theoretical studies and providing a recently updated knowledge to those practitioners and scholars in the field of pediatric gastroenterology, hepatology and nutrition. Pediatr Gastroenterol Hepatol Nutr publishes review articles, original articles, and case reports. All of the submitted papers are peer-reviewed. The journal covers basic and clinical researches on molecular and cellular biology, pathophysiology, epidemiology, diagnosis, and treatment of all aspects of pediatric gastrointestinal diseases and nutritional health problems.