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《Journal of Clinical Pediatric Surgery》 2017-06
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Clinicopathological analysis with different native liver survivals for biliary atresia after Kasai

Yu Chen;Zhan Jianghua;Gao Wei;Wang Zhenglu;Graduate School, Tianjin Medical University;Department of Pediatric Surgery,Tianjin Children's ,Hospital;Department of Transplantation Surgery,First Municipal Central Hospital;  
Objective To compare the survival conditions of different native livers in biliary atresia( BA) patients after Kasai operation and explore the pathological characteristics of liver in children with a longer survival time with hepatic pathology and biochemistry. Methods A total of 43 BA patients undergoing Kasai and liver transplantation( LT) were divided into 3 groups according to interval time between Kasai and LT:group 1( n = 17),interval time 6 months; group 2( n = 18),from 6 months to 2 years; group 3( n = 8), 2 years. A retrospective study was conducted for clinical data of each group including age at Kasai,occurrence of cholangitis and biochemical values pre-LT. Meanwhile,pathological examinations of liver pathology during Kasai and LT included hematoxylin-eosin( HE),Masson and immunohistochemical( CK19) staining for evaluating grade of liver fibrosis,extension of bile duct,cholestasis and infiltration of inflammatory cells.Results In three groups,the average ages at Kasai were 66. 65,58. 39,49. 63 days( P 0. 05); number of cases with cholangitis 12/17( 70. 6%),14/18( 77. 8%),4/8( 50%)( P 0. 05) and with frequent cholangitis 7/10( 41. 2%),12/18( 66. 7%),1/8( 12. 5%)( P 0. 05) post-Kasai; biochemical values preLT showed that the levels of AST,ALT,TBI,DBI and GGT in group 3 were lower than other groups and the differences not statistically significant. The grade of hepatic fibrosis was 3( 2-3),bile duct proliferation2( 1-2. 5),portal bile plug 1( 1-2. 5) and infiltration of inflammatory cells 3( 1. 5-3) during Kasai; Pathology during LT showed that the grades of hepatic fibrosis 4( 4-4),4( 4-4),4( 2-4)( P 0. 05),bile duct proliferation 3( 3-3),2( 1-3),0( 0-2)( P 0. 001),bile plug 3( 2. 5-3),1( 1-3),1( 1-3)( P 0. 001) and infiltration of inflammatory cells 2( 1-2),1. 5( 1-2),1( 1-1)( P 0. 05). The differences were statistically significant. Clinicopathological data showed earlier operations of BA patients and less occurring frequency of cholangitis,slower progress of hepatic fibrosis and milder proliferation of bile duct,cholestasis and inflammatory cell infiltration and longer survival time of native liver. Conclusion Age of Kasai and frequency of cholangitis are essential for the changes of native liver pathology and survival time of BA patients. For those with a longer native liver survival time,Kasai operation may resolve cholestasis and decrease inflammation infiltration so as to delay the progress of liver fibrosis.
【Fund】: 国家自然科学基金(81570471);; 天津市卫生行业重点攻关项目(14KG129)
【CateGory Index】: R726.5
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