Chinese Journal of Pediatric Surgery
中华医学会小儿外科学分会肝胆外科学组
DOI:10.3760/cma.j.cn421158-20220427-00308
表1 GRADE系统循证医学证据质量和推荐强度
表2 胆管炎临床诊断的6项指标
注:疑似胆管炎,满足A和B中任意2项;确诊胆管炎,满足A中1项和B中2项,或满足疑似胆管炎+血培养阳性;此定义适用于Kasai术后1年内的首次胆管炎发作;反映细菌感染的炎症指标包括中性粒细胞(NE)、C反应蛋白(CRP)、降钙素原(PCT);肝功能指标包括总胆红素(TB)、直接胆红素(DB)、总胆汁酸(TBA)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST);肝功能指标升高为AST、ALT>1.5倍正常范围和(或)高于之前水平,TB≥34 μmol/L和(或)较前水平升高,以DB升高为主
1. Hartley JL,Davenport M,Kelly DA.Biliary atresia[J].Lancet,2009,374(9702):1704⁃1713. DOI:10.1016/S0140-6736(09)60946-6.
2. van Heurn LWE,Saing H,Tam PKH.Cholangitis after hepatic portoenterostomy for biliary atresia:a multivariate analysis of risk factors[J].J Pediatr,2003,142(5):566⁃571. DOI:10.1067/mpd.2003.195.
3. Liu J,Dong R,Chen G,et al.Risk factors and prognostic effects of cholangitis after Kasai procedure in biliary atresia patients:a retrospective clinical study[J].J Pediatr Surg,2019,54(12):2559⁃2564. DOI:10.1016/j.jpedsurg.2019.08.026.
4. Baek SH,Kang JM,Ihn K,et al.The epidemiology and etiology of cholangitis after Kasai portoenterostomy in patients with biliary atresia[J].J Pediatr Gastroenterol Nutr,2020,70(2):171⁃177. DOI:10.1097/MPG.0000000000002555.
5. Davenport M.Adjuvant therapy in biliary atresia:hopelessly optimistic or potential for change?[J].Pediatr Surg Int,2017,33(12):1263⁃1273. DOI:10.1007/s00383-017-4157-5.
6. 詹江华,卫园园.胆道闭锁患儿Kasai术后胆管炎病因及诊疗状况[J].天津医药,2016,44(7):803⁃806. DOI:10.11958/20160236.
Zhan JH,Wei YY.The etiology and treatment of cholangitis after Kasai operation in biliary atresia patients[J].Tianjin Med J,2016,44(7):803⁃806. DOI:10.11958/20160236.
7. Zheng QP,Zhang SJ,Ge L,et al.Investigation into multi⁃centre diagnosis and treatment strategies of biliary atresia in mainland of China[J].Pediatr Surg Int,2020,36(7):827⁃833. DOI:10.1007/s00383-020-04679-z.
8. 中华医学会小儿外科学分会肝胆外科学组,中国医师协会器官移植医师分会儿童器官移植学组.胆道闭锁诊断及治疗指南(2018版)[J].中华小儿外科杂志,2019,40(5):392⁃398.DOI:10.3760/cma.j.issn.0253-3006.2019.05.003.
Section of Hepatobiliary Surgery, Branch of Pediatric Surgery, Chinese Medical Association;Section of Pediatric Hepatic Transplantation, Branch of Organ Transplantation,Chinese Medical Doctor Association. Guidelines for diagnosing & treating biliary atresia (2018 Edition)[J].Chin J Pediatr Surg,2019,40(5):392⁃398.DOI:10.3760/cma.j.issn.0253-3006.2019.05.003.
9. 单帅帅,王庆伟,文建国.临床指南和专家共识的基本概念与制定规范[J].中华小儿外科杂志,2020,31(2):107⁃111. DOI:10.3760/cma.j.issn.0253-3006.2020.02.003.
Shan SS,Wang QW,Wen JG.Fundamental concepts and formulating specifications of clinical guidelines and expert consensus[J].Chin J Pediatr Surg,2020,31(2):107⁃111. DOI:10.3760/cma.j.issn.0253-3006.2020.02.003.
10. Guyatt GH,Oxman AD,Vist GE,et al.GRADE:an emerging consensus on rating quality of evidence and strength of recommendations[J].BMJ,2008,336(7650):924⁃926. DOI:10.1136/bmj.39489.470347.AD.
11. 王皓洁,詹江华.胆道闭锁Kasai手术后胆管炎病因的研究进展[J].中华小儿外科杂志,2020,31(12):1148⁃1152. DOI:10.3760/cma.j.cn421158-20200223-00113.
Wang HJ,Zhan JH.Research advances in etiology of cholangitis after Kasai procedure[J].Chin J Pediatr Surg,2020,31(12):1148⁃1152. DOI:10.3760/cma.j.cn421158-20200223-00113.
12. Luo QF,Hao FB,Zhang MM,et al.Serum bacterial DNA detection in patients with cholangitis after Kasai procedure[J].Pediatr Int,2015,57(5):954⁃960. DOI:10.1111/ped.12737.
13. Li DD,Chen XA,Fu K,et al.Preoperative nutritional status and its impact on cholangitis after Kasai portoenterostomy in biliary atresia patients[J].Pediatr Surg Int,2017,33(8):901⁃906. DOI:10.1007/s00383-017-4118-z.
14. 郭鑫,孙雪,任红霞.102例胆道闭锁Kasai术后胆管炎分析[J].临床小儿外科杂志,2017,16(2):146⁃150. DOI:10.3969/j.issn.1671-6353.2017.02.010.
Guo X,Sun X,Ren HX.Analysis of cholangitis in patients with biliary atresia after Kasai operation[J].J Clin Pediatr Surg,2017,16(2):146⁃150. DOI:10.3969/j.issn.1671-6353.2017.02.010.
15. 张璟,林涛,黄柳明,等.胆道闭锁术后反复发作性胆管炎抗感染治疗的中长期随访[J].临床小儿外科杂志,2016,15(1):20⁃22. DOI:10.3969/j.issn.1671-6353.2016.01.006.
Zhang J,Lin T,Huang LM,et al.The result of medium to long term follow⁃ups after anti⁃infective therapy for recurrent cholangitis after Kasai operation[J].J Clin Pediatr Surg,2016,15(1):20⁃22. DOI:10.3969/j.issn.1671-6353.2016.01.006.
16. Yokoe M,Hata J,Takada T,et al.Tokyo Guidelines 2018:diagnostic criteria and severity grading of acute cholecystitis (with videos)[J].J Hepatobiliary Pancreat Sci,2018,25(1):41⁃54. DOI:10.1002/jhbp.515.
17. Calinescu AM,Madadi⁃Sanjani O,Mack C,et al.Cholangitis definition and treatment after Kasai hepatoportoenterostomy for biliary atresia:a Delphi process and international expert panel[J].J Clin Med,2022,11(3):494. DOI:10.3390/jcm11030494.
18. Lee JY,Lim LTK,Quak SH,et al.Cholangitis in children with biliary atresia:health⁃care resource utilisation[J].J Paediatr Child Health,2014,50(3):196⁃201. DOI:10.1111/jpc.12463.
19. 陈峋,苏海霞,陈秀奇,等.胆道闭锁术后胆管炎的病原菌分布特点及药敏分析[J].实用医学杂志,2018,34(3):435⁃438. DOI:10.3969/j.issn.1006-5725.2018.03.023.
Chen X,Su HX,Chen XQ,et al.Distributions of pathogenic bacteria and drug sensitivity in cholangitis after hepatico⁃portoenterostomy for biliary atresia[J].J Pract Med,2018,34(3):435⁃438. DOI:10.3969/j.issn.1006-5725.2018.03.023.
20. Luo Y,Zheng S.Current concept about postoperative cholangitis in biliary atresia[J].World J Pediatr,2008,4(1):14⁃19. DOI:10.1007/s12519-008-0003-0.
21. Chen G,Liu J,Huang YL,et al.Preventive effect of prophylactic intravenous antibiotics against cholangitis in biliary atresia:a randomized controlled trial[J].Pediatr Surg Int,2021,37(8):1089⁃1097. DOI:10.1007/s00383-021-04916-z.
22. 中华医学会小儿外科分会新生儿外科学组,小儿肝胆外科学组.中国大陆地区胆道闭锁诊断及治疗(专家共识)[J].中华小儿外科杂志,2013,34(9):700⁃705. DOI:10.3760/cma.j.issn.0253-3006.2013.09.014.
Section of Neonatology Surgery, Branch of Pediatric Surgery, Chinese Medical Association; Section of Hepatobiliary Surgery, Branch of Pediatric Surgery, Chinese Medical Association.Diagnosis and treatment of biliary atresia in Chinese Mainland (expert consensus)[J].Chin J Pediatr Surg,2013,34(9):700⁃705.DOI:10.3760/cma.j.issn.0253-3006.2013.09.014.
23. Cheng K,Molleston JP,JrBennett WE.Cholangitis in patients with biliary atresia receiving hepatoportoenterostomy:a national database study[J].J Pediatr Gastroenterol Nutr,2020,71(4):452⁃458. DOI:10.1097/MPG.0000000000002836.
24. Willot S,Uhlen S,Michaud L,et al.Effect of ursodeoxycholic acid on liver function in children after successful surgery for biliary atresia[J].Pediatrics,2008,122(6):e1236⁃e1241. DOI:10.1542/peds.2008-0986.
25. Qiu JL,Shao MY,Xie WF,et al.Effect of combined ursodeoxycholic acid and glucocorticoid on the outcome of Kasai procedure:a systematic review and meta⁃analysis[J].Medicine,2018,97(35):e12005. DOI:10.1097/MD.0000000000012005.
26. Lien TH,Bu LN,Wu JF,et al.Use of lactobacillus casei rhamnosus to prevent cholangitis in biliary atresia after Kasai operation[J].J Pediatr Gastroenterol Nutr,2015,60(5):654⁃658. DOI:10.1097/MPG.0000000000000676.
27. 郑帅玉,韦佳,翁一珍,等.益生菌对胆道闭锁术后胆管炎预防作用的前瞻对照研究[J].中华小儿外科杂志,2012,33(4):268⁃271. DOI:10.3760/cma.j.issn.0253-3006.2012.04.007.
Zheng SY,Wei J,Weng YZ,et al.A prospective controlled trial of probiotics on cholangitis after Kasai procedure for biliary atresia[J].Chin J Pediatr Surg,2012,33(4):268⁃271. DOI:10.3760/cma.j.issn.0253-3006.2012.04.007.
28. 柳静,陈芳,闫慧敏,等.胆道闭锁患儿术后的中药干预治疗[J].实用儿科临床杂志,2009(23):1838⁃1840. DOI:CNKI:SUN:SYQK.0.2009-23-020.
Liu J,Chen F,Yan HM,et al.Traditional Chinese medicine on biliary atresia in children after operation[J].J Appl Clin Pediatr,2009(23):1838⁃1840. DOI:CNKI:SUN:SYQK.0.2009-23-020.
29. Nightingale S,Stormon MO,O'Loughlin EV,et al.Early posthepatoportoenterostomy predictors of native liver survival in biliary atresia[J].J Pediatr Gastroenterol Nutr,2017,64(2):203⁃209. DOI:10.1097/MPG.0000000000001289.
30. 王培,冯杰雄.胆道闭锁术后胆管炎抗生素分级治疗的多中心研究方案[J].临床小儿外科杂志,2019,18(11):922⁃926. DOI:10.3969/j.issn.1671-6353.2019.11.006.
Wang P,Feng JX.The antibiotics treatment of cholangitis Post⁃Kasai Portoenterostomy:a multi⁃center study protocol[J].J Clin Pediatr Surg,2019,18(11):922⁃926. DOI:10.3969/j.issn.1671-6353.2019.11.006.
31. 詹江华.胆道闭锁诊疗流程(草案)[J].中华小儿外科杂志,2013,34(2):147⁃149. DOI:10.3760/cma.j.issn.0253-3006.2013.02.018.
Zhan JH.Biliary atresia diagnosis and treatment process draft)[J].Chin J Pediatr Surg,2013,34(2):147⁃149. DOI:10.3760/cma.j.issn.0253-3006.2013.02.018.
32. Li DD,Wang P,He Y,et al.Intravenous immunoglobulin for the treatment of intractable cholangitis after Kasai portoenterostomy in biliary atresia patients[J].Pediatr Surg Int,2018,34(4):399⁃404. DOI:10.1007/s00383-018-4240-6.
33. Ginström DA,Hukkinen M,Kivisaari R,et al.Biliary atresia⁃associated cholangitis:the central role and effective management of bile lakes[J].J Pediatr Gastroenterol Nutr,2019,68(4):488⁃494. DOI:10.1097/MPG.0000000000002243.
34. Shirota C,Uchida H,Ono Y,et al.Long⁃term outcomes after revision of Kasai portoenterostomy for biliary atresia[J].J Hepatobiliary Pancreat Sci,2016,23(11):715⁃720. DOI:10.1002/jhbp.395.
35. Bondoc AJ,Taylor JA,Alonso MH,et al.The beneficial impact of revision of Kasai portoenterostomy for biliary atresia:an institutional study[J].Ann Surg,2012,255(3):570⁃576. DOI:10.1097/SLA.0b013e318243a46e.
引用本文: 中华医学会小儿外科学分会肝胆外科学组.胆道闭锁Kasai术后胆管炎诊疗专家共识(2022版)[J].中华小儿外科杂志,2022,43(9):769-774. (Expert Consensus on Diagnosing and Treating Cholangitis after Kasai Operation for Biliary Atresia (2022 Edition)[J].CHINESE JOURNAL OF PEDIATRIC SURGERY,2022,43(9):769-774.)
DOI:10.3760/cma.j.cn421158-20220427-00308
出版日期:2022-09-15
Chinese Journal of Pediatric Surgery
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