胆道闭锁Kasai术后辅助治疗研究进展

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胆道闭锁(BA)是累及肝内外胆管的一种进行性疾病,目前广泛采用的治疗策略是行肝门空肠吻合术(Kasai术),但约60%的患儿Kasai术后效果不佳,继而需要行肝移植.虽然患儿本身BA分型、手术方式(腹腔镜或传统开放)、手术时年龄、术时肝脏病变情况均是影响BA患儿Kasai术后生存的因素,但是BA术后的辅助治疗仍有较大的改进空间.近年来对于BA术后应用激素、胆汁酸代谢药物、抗生素、益生菌等的报道较多,为了使BA患儿获得更好的预后,该文章就BA术后辅助治疗的研究进展进行综述,进一步探讨辅助治疗改善BA患儿预后的价值.
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胆管炎是胆道闭锁Kasai术后的常见并发症,对患儿的生活质量及自肝生存均有较大影响.术中患儿自身肝脏状况会影响术后胆汁引流,Kasai术后胆管炎的发生与胆汁引流状况关系密切.空肠胆支内存在的细菌因肠道环境改变而大量繁殖可能是胆管炎发生的主要原因,远端空肠内容物反流入空肠胆支中也可诱发胆管炎.除了直接逆行感染外,肠道细菌突破肠黏膜经门静脉入肝,也是导致胆管炎发生的原因之一.
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