Kasai门肠造口术治疗先天性心脏病患者的结果：一种沉默的合并症

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-03-18 DOI:10.1016/j.jpedsurg.2025.162279

Mario O'Connor , Hugo R. Martinez , Maria E. Hoyos , Charles D. Fraser , Andrew Well

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引用次数: 0

摘要

胆道闭锁（BA）是儿童终末期肝病最常见的病因。大约5%-15%的BA患者被诊断为先天性心脏病（CHD）。尽管BA患者中冠心病诊断的患病率很高，但Kasai门肠造口术（KPE）在冠心病人群中的效果仍未得到探索。方法：这是一项2012-2022年美国外科医师学会国家外科质量改进计划-儿科（NSQIP-P）数据库的回顾性研究。所有接受KPE的患者均被纳入。使用先前验证的ICD9/10代码识别冠心病患者。结果：在研究期间共有854例患者接受了KPE。在该队列中，502例（59%）为女性，342例（40%）为非西班牙裔白人，中位年龄为57.0[IQR:40.0-72.0]天，中位体重为9.4[IQR:8.1-10.7]公斤。89例（10%）患者被诊断为冠心病。其中63例（7%）诊断为单纯性冠心病，26例（3%）诊断为复合性冠心病。7例（1%）患者诊断为单心室（SV-CHD）。值得注意的是，没有发现住院死亡病例。与非冠心病相比，单纯性冠心病（OR:2.51;95%CI:1.45-4.36,p=0.001）和复杂型冠心病（OR:3.20;95%CI:1.30-7.87,p=0.011）的并发症风险增加。此外，与非冠心病患者相比，合并冠心病患者接受Kasai相关再干预的几率更高（OR:5.01;95%CI:1.76-14.22,p=0.002）。倾向评分匹配后，与非冠心病患者相比，冠心病诊断仅与并发症风险增加相关（OR:2.50;95%CI:1.30-4.81,p=0.005）。结论：10%的KPE患儿有冠心病诊断。KPE对冠心病患者似乎是安全的，但与医院资源利用率增加有关。需要进一步的研究来了解冠心病诊断对KPE后长期预后的影响。研究类型：回顾性评价证据等级：3级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Outcomes of Kasai Portoenterostomy in Patients With Congenital Heart Disease: A Silent Comorbidity

Introduction

Biliary atresia (BA) is the most common cause of end-stage liver disease in children. Around 5 %–15 % of patients with BA have a congenital heart disease (CHD) diagnosis. Despite high prevalence of a CHD diagnosis in patients with BA, outcomes of Kasai portoenterostomy (KPE) in the CHD population remain unexplored.

Methods

This is a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database from 2012 to 2022. All patients undergoing KPE were included. Patients with CHD were identified using previously validated ICD9/10 codes.

Results

A total of 854 patients underwent a KPE during the study period. Of this cohort, 502 (59 %) were female, 342 (40 %) White Non-Hispanic, median age of 57.0[IQR: 40.0–72.0] days, and a median weight of 9.4 [IQR: 8.1–10.7] kilograms. A total of 89 (10 %) patients had a diagnosis of CHD. Of those, 63 (7 %) had a simple-CHD diagnosis and 26 (3 %) a complex-CHD diagnosis. A single-ventricle (SV-CHD) diagnosis was present in 7 (1 %) patients. Notably, no in-hospital mortalities were found. When compared to non-CHD, simple-CHD (OR: 2.51; 95 % CI: 1.45–4.36, p = 0.001) and complex-CHD (OR: 3.20; 95 % CI: 1.30–7.87, p = 0.011) had increased risk for any complication. Furthermore, when compared to non-CHD complex-CHD patients had higher odds of undergoing a Kasai related reintervention (OR: 5.01; 95 % CI: 1.76–14.22, p = 0.002. After propensity score matching, when compared to non-CHD a CHD diagnosis was only associated with an increased risk for any complication (OR: 2.50; 95 % CI: 1.30–4.81, p = 0.005).

Conclusion

A CHD diagnosis is present in 10 % of children undergoing KPE. KPE appears to be safe in patients with CHD, but associated with increased in-hospital resource utilization. Further studies are needed to understand the impact of a CHD diagnosis on the long-term outcomes after KPE.

Type of study

Retrospective Review.

Level of evidence

Level 3.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.