临床小儿外科杂志2025，Vol.24Issue(5)：442-447,6.DOI:10.3760/cma.j.cn101785-202407004-009
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
The effect of different prophylactic intravenous antibiotic regimens on the survival of children with cholangitis and autologous liver after biliary atresia surgery
摘要
Abstract
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.关键词
胆道闭锁/胆管炎/预防/抗生素预防/治疗结果Key words
Biliary Atresia/Cholangitis/Prevention/Antibiotic Prevention/Treatment Outcome Prophylaxis引用本文复制引用
何晓金,刘雪来,叶茂,李旭,钟旭丽,刘洁,郭茂文,张建民..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[J].临床小儿外科杂志,2025,24(5):442-447,6.基金项目
首都儿科研究所所级课题(LCYJ-2023-22) （LCYJ-2023-22）
北京市自然科学基金(7222015) （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) （LCYJ-2023-22）
Beijing Natural Science Founda-tion(7222015) （7222015）
Beijing Municipal Health Commission"Belt and Road"International Health Cooperation Pro-ject and World Health Organization Cooperation Center Project （）
