胆道闭锁手术后不同预防性静脉抗生素方案对患儿胆管炎及自体肝生存情况的影响OA北大核心
The effect of different prophylactic intravenous antibiotic regimens on the survival of children with cholangitis and autologous liver after biliary atresia surgery
目的 探讨胆道闭锁手术后不同预防性静脉抗生素方案对患儿胆管炎及自体肝生存情况的影响.方法 本研究为回顾性研究,收集2015年6月至2018年1月首都医科大学附属首都儿童医学中心治疗的符合入组标准的Ⅲ型胆道闭锁患儿106例为研究对象.根据术后所使用的抗生素种类分为头孢哌酮钠舒巴坦钠组(n=44)和亚胺培南西司他丁钠组(n=62),以术后胆管炎发生率、复杂程度、发作时间和频率以及黄疸消退时间等为指标,比较两组术后6个月内的近期疗效及术后6年自体肝生存情况.结果 头孢哌酮钠舒巴坦钠组和亚胺培南西司他丁钠组术后6个月胆管炎发生率(72.7％比 58.1％,32/44 比 36/62)、发病复杂程度[单纯性胆管炎(34.1％比 21.0％,15/44 比 13/62)、难治性胆管炎(38.6％比37.1％,17/44比23/62)]差异无统计学意义(P＞0.05).头孢哌酮钠舒巴坦钠组和亚胺培南西司他丁钠组术后6个月胆管炎的发生频率[偶发胆管炎(22.7％比21.0％,10/44比13/62)、频发胆管炎(50.0％比37.1％,22/44比23/62)]、黄疸清除率[术后3个月清除率(29.5％比 35.5％,13/44 比 22/62)、术后 6 个月清除率(45.5％比 51.6％,20/44 比 32/62)]及术后6年自体肝的生存情况比较[自体肝生存正常(47.7％比54.8％,21/44比34/62)、术后6个月内行肝移植(2.3％比 3.2％,1/44 比 2/62)、术后 1 年内肝移植(31.8％比 29.0％,14/44 比 18/62)、术后 6年内肝移植(50.0％比43.5％,22/44比27/62)、死亡(2.3％比1.6％,1/44比1/62)],差异均无统计学意义(P＞0.05).头孢哌酮钠舒巴坦钠组术后1个月内胆管炎的发生率高于亚胺培南西司他丁钠组(45.5％比25.8％,20/44比16/62),差异有统计学意义(P＜0.05),但两组术后3个月内胆管炎的发生率(68.2％比58.1％,30/44比36/62)及术后6个月内胆管炎的发生率(72.7％比58.1％,32/44比36/62)差异无统计学意义(P＞0.05).结论 Kasai术后预防性使用不同抗生素对预防胆管炎和改善自体肝生存情况疗效相似,但碳青霉烯类较头孢类更能有效降低早期胆管炎的发生率.
Objective To investigate the impact of different prophylactic intravenous antibiotic regimens on the prevention of cholangitis and the survival of native livers in children following surgery for biliary atresia.Methods This retrospective study including 106 type Ⅲ biliary atresia patients treated at Capital center for children's health,Capital medical uviversity from June 2015 to January 2018.Patients were divided into a cef-operazone-sulbactam group(n=44)and an imipenem-cilastatin group(n=62)based on postoperative proph-ylactic antibiotic type.Key outcome measures included cholangitis incidence,severity,onset timing,recurrence frequency,and jaundice resolution time.The study assessed short-term outcomes within 6 months postoperatively and long-term outcomes concerning native liver survival over a 6-year follow-up period.Results No significant differences were observed between the cefoperazone-sulbactam group and the imipenem-cilastatin group in the 6-month postoperative cholangitis incidence(72.7％vs.58.1％,32/44 vs.36/62),the severity of cholangitis[simple cholangitis(34.1％vs.21.0％,15/44 vs.13/62)and refractory cholangitis(38.6％vs.37.1％,17/44 vs.23/62)],the frequency of cholangitis episodes[occasional cholangitis(22.7％vs.21.0％,10/44 vs.13/62)and recurrent cholangitis(50.0％vs.37.1％,22/44 vs.23/62)],jaundice clearance rates[3-month clearance rate(29.5％vs.35.5％,13/44 vs.22/62)and 6-month clearance rate(45.5％vs.51.6％,20/44 vs.32/62)],or the native liver survival status at 6 years[normal native liver survival(47.7％vs.54.8％,21/44 vs.34/62),transplantation within 6 months(2.3％vs.3.2％,1/44 vs.2/62),transplant within 1 year(31.8％vs.29.0％,14/44 vs.18/62),transplantation within 6 years(50.0％vs.43.5％,22/44 vs.27/62),and death(2.3％vs.1.6％,1/44 vs.1/62)](P＞0.05).However,there was no significant difference in the incidence of cholangitis between the two groups within 3 months after operation(68.2％vs.58.1％,30/44 vs.36/62)and 6 months after operation(72.7％vs.58.1％,32/44 vs.36/62)(P＞0.05).Conclusions The prophylactic use of different antibiotics after Kasai surgery demonstrated comparable efficacy in preventing cholangitis and maintaining native liver survival.However,carbapenems were more effective than cephalosporin in reducing early-onset cholangitis.
何晓金;刘雪来;叶茂;李旭;钟旭丽;刘洁;郭茂文;张建民
首都医科大学附属首都儿童医学中心药学部,北京 100020首都医科大学附属首都儿童医学中心普通外科,北京 100020首都医科大学附属首都儿童医学中心普通外科,北京 100020首都医科大学附属首都儿童医学中心普通外科,北京 100020首都医科大学附属首都儿童医学中心药学部,北京 100020首都医科大学附属首都儿童医学中心药学部,北京 100020首都医科大学附属首都儿童医学中心药学部,北京 100020首都医科大学附属首都儿童医学中心药学部,北京 100020
胆道闭锁胆管炎预防抗生素预防治疗结果
Biliary AtresiaCholangitisPreventionAntibiotic PreventionTreatment Outcome Prophylaxis
《临床小儿外科杂志》 2025 (5)
442-447,6
首都儿科研究所所级课题(LCYJ-2023-22)北京市自然科学基金(7222015)北京市卫生健康委员会"一带一路"国际卫生健康合作项目和世界卫生组织合作中心项目 Capital Institute of Pediatrics Project(LCYJ-2023-22)Beijing Natural Science Founda-tion(7222015)Beijing Municipal Health Commission"Belt and Road"International Health Cooperation Pro-ject and World Health Organization Cooperation Center Project
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