优化卡萨伊病后治疗胆管动症:平衡原生肝脏存活率和移植时间
Omid Madadi-Sanjani1, Marie Uecker2, Gordon Thomas3
1Department of Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
概括
在Kasai portoenterostomy (KPE) 之后的救援程序可以在有并发症的胆道缩 (BA) 患者中延长本源肝存活 (NLS). 然而,对于大多数人来说,肝移植仍然是不可避免的,需要多学科团队讨论.
科学领域:
- 儿科手术 儿科手术
- 肝病学 肝病学是一种肝病学.
- 移植医学 移植医学
背景情况:
- 胆管缩 (BA) 是儿童肝移植的主要原因.
- 卡萨伊口腔静脉切除术 (KPE) 是一种缓解性手术,用于恢复胆汁的流动.
- 虽然一些患者在KPE后实现了黄清除,但慢性肝病后续可能会影响长期本源肝存活率 (NLS).
研究的目的:
- 为了提供一个全面的概述,在BA患者中KPE后执行的救援程序.
- 讨论这些干预措施延长NLS的指示和局限性.
- 分析BA患者各种救援程序的结果.
主要方法:
- 基于PubMed的文献搜索KPE后的干预措施,以延长NLS.
- 包括从案例报告,回顾性研究和登记册中获得的数据.
- 分析手术和放射性干预,包括重复卡赛,胆湖和胆结炎的手术,以及门高血压的变位.
主要成果:
- 分析了15项涉及794名接受KPE后救援手术的患者的研究.
- 干预措施包括 redo-Kasai (n=710),胆汁湖/胆管炎的手术 (n=14),分流手术 (n=49) 和 TIPS (n=21).
- 患者在干预时的年龄大大不同,从新生儿到成年人,突出了一些手术的长期适用性.
结论:
- 救援程序可以支持在BA患者的NLS在BA患者的KPE后并发症.
- 挽救手术的适应症是具体的,肝移植是大多数人最终的解决方案.
- 胆湖和门性高血压的程序为部分患者提供了可行的选择,需要多学科专家团队的评估.
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