| Objective:To study the factors affect the survival time of native liver in children with biliary atresia after Kasai surgery.Including the age of surgery,frequency and time of cholangitis,ductular reaction,bile ductal plate malformation.And to analyze the pathological factors affect the occurrence of cholangitis.Methods:1.A total of 42 children diagnosed as BA and performed Kasai surgery in Tianjin Children's Hospital from January 2011 to December 2012 were enrolled.The survival time of native liver was divided into 3 groups.Group A(n=15)was the BA children whose survival time of native liver after Kasai surgery was more than 5 years.Group B(n=11)was the BA children with native liver survival time between 2 and 5 years.Group C(n=16)were BA children who died within 2 years after Kasai surgery or received liver transplantation due to liver failure.The clinical data of the children were retrospectively analyzed,including the age of Kasai surgery,the time and frequency of cholangitis,and the outcome of prognosis(long-term native liver survival,liver transplantation,and death).To analyze whether the age of Kasai surgery,the time and frequency of cholangitis affect the survival time of native liver in children with biliary atresia.2.The 42 children with BA who were diagnosed as BA and performed Kasai surgery in Tianjin Children's Hospital from January 2011 to December 2012 were selected as BA group,the subgroup of BA group was the same as the above;the control group was selected from 10 children with choledochal cyst.10 children with cholestasis;5 cases with autopsy.Wedge-shaped resection of BA,common bile duct cyst,cholestasis of children with liver right lobe leading edge specimen during the operation,wedge resection of non-hepatobiliary disease died of liver right lobe leading edge specimen,liver tissue specimens for hematoxylin/eosin(HE),Masson and immunohistochemical staining.HE staining was used to observe the pathological changes of liver tissue,bile duct hyperplasia,biliary thrombosis and inflammatory cell infiltration.Masson staining was used to observe the degree of liver fibrosis in liver tissue.Immunohistochemical staining was used to qualitatively and quantitatively analyze the expressions of ductular reaction related antibodies including CK7,CK19,CD56 and EpCAM in different groups.HE staining and immunohistochemical staining of CK19 were used to observe the incidence of bile ductal plate malformation.To analyze whether the ductular reaction and ductal plate malformation affect the survival time of native liver.3.By retrospective analysis of the data of the incidence of cholangitis and the survival time of native liver in BA children,it was found that the occurrence time and frequency of cholangitis affected the survival time of native liver.Add 30 children with BA from January 2016 to December 2016,a total of 72 children(34 males and38 females).According to the Japan Ohkuma's liver fibrosis to group classification standard,divided into liver fibrosis levels?(n=6),?(n=25),?(n=30),?(n=11).Liver tissue samples obtained during the operation were stained with hematoxylin/eosin(HE)and Masson to evaluate the degree of fibrosis,and immunohistochemical staining was used to detect the expression of specific markers of inflammatory cells such as T lymphocyte surface antigen(CD4,CD8)and macrophage-specific antibody(CD68).Combined with Kasai postoperative follow-up data,the relationship between the degree of infiltration of inflammatory cells in liver tissue and the degree of liver fibrosis in BA children and Kasai postoperative cholangitis was analyzed.Results:1.1 patient in group A underwent liver transplantation for liver failure at 75months,and the other children had long-term native liver survival until the last follow-up.7 patients in group B underwent liver transplantation for liver failure,and4 patients died due to liver failure.7 patients in group C underwent liver transplantation for liver failure,and 9 patients died of liver failure.2.The age of Kasai operation in group A,B and C was(61.93±10.27)d,(63.27±11.06)d,(67.56±19.98)d.There was no significant difference among the three groups(F=0.595,P=0.556).3.The incidence of cholangitis,early cholangitis,and frequent cholangitis after Kasai patients with 42 patients in BA was 54.8%,37.5%,and 22.2%,respectively.The incidence of cholangitis,early cholangitis,and frequent cholangitis in children with group A,B,and C was(33.3%,13.3%,6.7%),(54.5%,36.4%,27.3%),(75).%,56.3%,50%),respectively.The incidence of early cholangitis and frequent cholangitis in the three groups was related to the survival time of native liver,and the difference was statistically significant(?~2=6.214,P=0.045;?~2=7.136,P=0.028).Pairwise comparison showed that the incidence of cholangitis,early cholangitis and frequent cholangitis in group A was significantly lower than that in group C(P<0.05).4.A total of 2.38%(1/42)of the children were associated with extrahepatic congenital malformations(mirror right ventricular and atrial septal defects).5.The degrees of hepatic fibrosis,bile duct hyperplasia and bile embolus score in BA group were higher than those in another three groups and the differences were statistically significant(~2=36.244,P=0.000;?~2=54.644,P=0.000;?~2=26.976,P=0.000).6.They are significant differences expression of CK7,CK19,CD56 and EPCAM in liver tissues of BA,CC,CS and control group and the expression of BA group was significantly greater than other groups(F=131.967,P=0.000;F=1726.885,P=0.000;F=98.141,P=0.000;F=73.642,P=0.000).7.The expression levels of CK7,CK19,CD56 and EPCAM were different in the three groups with different native liver survival time,and the difference was statistically significant(F=127.91,P=0.000;F=5.958,P=0.006;F=93.292,P=0.000;F=51.824,P=0.000).8.The incidence of biliary malformation in group A,B,and C was statistically significant(?~2=6.866,P=0.032).The difference in native liver survival time was less than 2 years(group C)compared with children with native liver survival time greater than 2 years(group A+B),the difference was statistically significant(?~2=6.108,P=0.013).9.All 72 children with BA were followed up.The incidences of cholangitis,early cholangitis and frequent cholangitis were 55.6%,37.5%,and 22.2%,respectively.There was a statistically significant difference in the incidence of cholangitis,early cholangitis,and frequent cholangitis after Kasai in children with different liver fibrosis grades(?~2=10.268,P=0.016;?~2=8.390,P=0.039;?~2=9.125,P=0.028).10.Pathological results showed that lymphocyte infiltration was predominant in liver tissue.The expression of CD4,and CD8 in group?,?was higher than that in group?,?.There was no significant difference in the expression of CD68between the groups.Conclusion:1.Age had little effect on the survival time of native liver in BA children.Early cholangitis and recurrent cholangitis may affect the survival time of native liver in BA children.2.Ductular reaction and ductal plate malformation can affect the survival time of native liver in children with BA.The expression of antibodies CK7,CD56 and EpCAM related to ductular reaction is abundant,and the existence of DPM can affect the survival time of native liver.3.The postoperative cholangitis after Kasai operation for patients with BA is correlated with the degree of liver fibrosis and liver tissue inflammatory cells especially T lymphocyte subgroups. |
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