Pediatric Gastroenterology, Hepatology & Nutrition

  • 제27권4호
  • /
  • Pages.224-235
  • /
  • 2024
  • /
  • 2234-8646(pISSN)
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  • 2234-8840(eISSN)
대한소아소화기영양학회 (The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition)
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Combined Predictors of Long-Term Outcomes of Kasai Surgery in Infants with Biliary Atresia

  • Anna Degtyareva (Department of Pediatric, Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology) ;
  • Medan Isaeva (Department of Research, NPF DNA-Technology LLC.) ;
  • Elena Tumanova (Department of Pathological Anatomy and Clinical Pathological Anatomy, Pirogov Russian National Research Medical University) ;
  • Elena Filippova (Department of Ultrasound Diagnostics in Neonatology and Pediatrics, Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology) ;
  • Anna Sugak (Department of Ultrasound Diagnostics in Neonatology and Pediatrics, Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology) ;
  • Alexander Razumovsky (Division of Thoracic Surgery, Department of Moscow Healthcare, Filatov Children's City Clinical Hospital) ;
  • Nadezhda Kulikova (Division of Thoracic Surgery, Department of Moscow Healthcare, Filatov Children's City Clinical Hospital) ;
  • Marina Albegova (Department of Pediatric, Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology) ;
  • Denis Rebrikov (Institute of Translational Medicine, Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology)
  • 투고 : 2024.01.10
  • 심사 : 2024.04.21
  • 발행 : 2024.07.15
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초록

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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참고문헌

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