胆道闭锁术前核心针活检后术中楔形活检的临床应用

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-04-28 DOI:10.1016/j.amjsurg.2025.116367

Christopher Nemeh , Nicholas Schmoke , Yeu Sanz Wu , Pengchen Wang , Stephen M. Lagana , Helen Remotti , Mercedes Martinez , Pooja Reddy Spector , Robert A. Cowles , Angela Kadenhe-Chiweshe , Paul Kurlansky , Vincent Duron , Steven Stylianos

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引用次数: 0

摘要

在Kasai门肠造口术治疗胆道闭锁时，儿科外科医生经常进行术中肝楔活检，尽管术前已有核心针活检。我们进行了一项单机构回顾性研究，分析了2004年至2023年术前因素、bats - ludwig纤维化分期（术前经皮核针穿刺和术中楔形活检）和原生肝患者的生存率。在116例患者中，87例患者同时进行了术前和术中活检，其中30/87（34.5%）患者的结果不一致。在不一致的样本中，术中楔形活检在97%的活检中超过了bats - ludwig评分系统。中心针（p = 0.80）和楔型（p = 0.18）纤维化分期与1年的原生肝生存均无相关性。手术年龄（58天vs. 63天，p = 0.04）、天冬氨酸转移酶（145对195 U/L， p = 0.05）和丙氨酸转移酶（108对143 U/L， p = 0.03）与1年肝脏生存有关。我们的数据表明术前核心活检后，术中常规楔形活检可能没有必要。

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Clinical utility of intraoperative wedge biopsies after preoperative core needle biopsies in biliary atresia

Pediatric surgeons often obtain intraoperative liver wedge biopsies during Kasai portoenterostomy for biliary atresia despite an existing preoperative core needle biopsy. We conducted a single-institution retrospective review analyzing preoperative factors, Batts-Ludwig fibrosis stage (preoperative percutaneous core needle and intraoperative wedge biopsies), and survival with native liver from 2004 to 2023. Of 116 patients, 87 underwent both preoperative and intraoperative biopsies, with discordant results observed in 30/87 (34.5 %) patients. Of the discordant samples, intraoperative wedge biopsies upstaged the Batts-Ludwig scoring system in 97 % of biopsies. Neither the core needle (p = 0.80) nor wedge (p = 0.18) fibrosis stage correlated with native liver survival at one year. Age at surgery (58 vs. 63 days, p = 0.04), aspartate transferase (145 vs. 195 U/L, p = 0.05), and alanine transferase (108 vs. 143 U/L, p = 0.03) demonstrated associations with native liver survival at one year. Our data suggests that routine intraoperative wedge biopsies may not be necessary after preoperative core biopsies.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.