Comparative Study Of Laparoscopy And Open Kasai On The Effects Of Liver Transplantation In Children

Objective: To explore the effect of laparoscopic and open Kasai operation on liver transplantation in children and the surgical effect after liver transplantation.Methods:The clinical data of 39 patients undergoing Kasai postoperative liver transplantation in our hospital from July 2017 to October 2019 were retrospectively analyzed and divided into 2 groups according to surgical methods.15 patients undergoing laparoscopic Kasai postoperative liver transplantation(group A: Laparoscopic Kasai group);24 cases of liver transplantation after open Kasai operation(group B: open Kasai group).The clinical data of the two groups of children before and after liver transplantation were analyzed and compared.Results:A total of 39 cases in this study,15 cases in group A,24 cases in group B;general information before surgery: age at transplantation(M)(group A: 9(5,44),group B: 9(4,105),P=0.921),body weight at the time of transplantation(Kg)(Group A: 7.5(5,13.5),Group B: 7.5(5.5,28.5),P=0.943),Childhood End-stage Liver Disease(PLED)score(Group A: 2.13±5.99,Group B: 6.33±9.45,P=0.098),transplant waiting time(d)(Group A: 237(86,1274),Group B: 245.5(66,3110),P=0.098),white blood cells(WBC)(10 *9/L)(Group A: 10.88(6.36,22),Group B: 11.29(2.9,33.68),P>0.99),C-reactive protein(CRP)(mg/L)(Group A: 2.31(0.8,60.55),Group B: 6.66(0.8,192),P=0.202),procalcitonin(PCT)(ng/m L)(Group A: 0.205(0.033,0.936),Group B: 0.344(0.0139,5.19),P=0.107),lactic acid(mmol/L)(Group A: 1.72±0.99,Group B:1.63±1.0,P=0.791)There was no statistically significant difference between the two groups(P>0.05);Intraoperative Data: Total operation time(min)(group A:590.6±108.9,group B: 781.1±263.0,P=0.04),diseased liver cutting time(min)(group A: 250.8±81.2,group B: 309.2±90.6,P=0.049),time to isolate the first hepatic port(min)(Group A: 37.1±17.3,Group B: 53.6±23.6,P=0.026),bleeding volume(ml)(Group A: 310(100,800),B Group: 825(120,4800),P<0.001),red blood cell(ml)infusion(Group A: 390(130,520),Group B: 520(260,1885),P <0.001),liver transplantation abdominal adhesion score(Group A: 7(3,15),Group B: 10(4,18),P=0.035)The difference between the two groups was statistically significant(P<0.05);warm ischemic time(s)(Group A :104(73,212),Group B: 135(40,295),P=0.131),cold ischemia time(min)(Group A: 121(59,437),Group B: 136(46,464),P=0.558),no liver Period(Group A: 63.07±14.26,Group B: 67.54±19.59,P=0.449),graft mass to recipient mass ratio(GRBW)(Group A: 3.60±1.15,Group B: 3.36±1.39,P=0.573)There was no statistically significant difference between the two groups(P>0.05);postoperative general situation: time to eat(d)(Group A: 2(1,3),Group B: 3(2,9),P=0.002),bowel movement time(d)(Group A: 4(1,11),Group B: 6.5(1,15),P=0.045),ICU hospital stay(d)(Group A: 4(3,10),Group B: 8(3,15),P=0.039),ventilator use time(h)(Group A: 38(1,92),Group B:59.5(12,343),P= 0.042)The difference between the two groups was statistically significant(P<0.05);postoperative hospital stay(d)(Group A: 29.2±7.95,Group B: 34.5±14.75,P=0.213),aspartate aminotransferase(AST)Normal time(d)(Group A: 7.33±2.61,Group B: 8.23±2.07,P=0.245),Alanine aminotransferase(ALT)normal time(d)(Group A: 11.87±4.868,Group B :13.18±5.586,P=0.464)There was no significant difference between the two groups(P>0.05);postoperative complications: intestinal complications(6.7% in group A,8.3% in group B,P>0.99),Vascular complications(0% in group A,4.2% in group B,P>0.99),rejection(6.7% in group A,16.7% in group B,P=0.631),biliary complications(6.7% in group A,B Group: 0%,P=0.385)The difference between the two groups was not statistically significant(P>0.05).The incidence of pulmonary complications(33.3%% in group A,70.8%% in group B,P=0.045)was significantly different between the two groups(P<0.05).The postoperative survival rate of the recipients(100% in group A,91.7% in group B,P=0.257)was not significantly different between the two groups(P>0.05).Conclusions:Compared with open Kasai surgery,laparoscopic Kasai reduces the adhesion level of the abdominal cavity,thereby reducing the difficulty of subsequent liver transplantation,reducing bleeding and total operation time during liver transplantation,which is beneficial to the rapid recovery of patients after surgery and shortens the length of hospitalization.Different Kasai methods before liver transplantation can affect the subsequent liver transplantation,but it does not affect the overall survival rate of patients after liver transplantation.