Biliyer Atrezili Olgularda Kasai Ameliyatı Sonrası Sağkalımı Öngörebilecek Erken Belirteçlerin İncelenmesi

Abstract

Amaç: Kasai yöntemi ile yapılan portoenterostomi (KPE), biliyer atrezi olgularının tedavisinde öncelikli seçenek olmaya devam etmektedir. Bu çalışmanın amacı, KPE yapılan olgularda, hangi erken belirteçlerin prognozu belirlemede değerli olabileceğini tespit etmektir. 

Araçlar ve Yöntem: Merkezimizde 2000 ile 2012 yılları arasında bu yöntem ile ameliyat edilen 35 olgunun bilgileri geriye dönük olarak incelendi. Karaciğer nakli gerektiren veya ölen olgular kötü prognoz grubu (KPG)(n=21); ameliyat sonrası kendi karaciğer dokuları ile hayatını devam ettirebilen olgular ise İyi Prognoz Grubu (İPG)(n=14) olarak tanımlandı. Olguların demografik verileri, ameliyat öncesi ve sonrasına ait karaciğer işlev test sonuçları ve patoloji raporları incelendi. Karşılaştırmalar için parametrik olmayan testler ve sınır değerlerinin tespiti için de alıcı işletim karakteristiği (ROC) testi kullanıldı. 

Bulgular: Ameliyat sonrasında toplam bilirubin (TB) ve direkt bilirubin (DB) seviyeleri sırasıyla KPG’de 10.9 (6.6-22.3) mg/dL ve 8.6 (5.1-16.1) mg/dL; İPG’de ise 8.3 (4.0-14.2) mg/dL ve 5.7 (2.9-10.2) mg/dL olarak ölçüldü. Her iki bilirubin düzeyleri arasında istatiksel olarak anlamlı fark olduğu tespit edildi (p=0.004, p=0.003). Alıcı işletim karakteristiği testinde; TB için 8.84 mg/dL sınır değer seçildiğinde duyarlılık %75 ve özgüllük %62; DB için 7.21 mg/dL sınır değer seçildiğinde duyarlılık %78.6 ve özgüllük %65 olarak tespit edildi. Duktal plak malformasyonu (DPM) varlığı İPG’de 4 olguda (%29) raporlanırken, KPG’ne dahil olan olguların hiçbirinde görülmedi ve istatistik olarak anlamlı saptandı (p=0.047). 

Sonuç: Ameliyat sonrası erken dönemde ölçülen DB ve TB seviyeleri, iyi prognozu işaret eden güvenilir belirteçler olarak değerlendirilebilir. Duktal plak malformasyonu varlığı da anlamlı bulunmuştur; ancak önemini açığa çıkarmak için daha büyük vaka gruplarını içeren çalışmalarla değerlendirilmesi gerekmektedir.

Keywords

• duktal plak malformasyonu
• bilirubin
• portoenterostomi

Determining the Early Clues for the Outcome of Biliary Atresia Patients After Kasai's Operation

Abstract

Purpose: Kasai's operation is still the initial step in the management of biliary atresia (BA). This study aims to identify the early factors predicting the event-free survival after Kasai portoenterostomy (KPE). 

Materials and Methods: In this retrospective study, records of 35 cases that underwent KPE between 2000 and 2012 were reviewed. Cases who died or needed liver transplantation were defined as the poor prognosis group (PPG) (n=21) and cases with event-free survival were defined as the good prognosis group (GPG)(n=14). Demographic data, preoperative and postoperative liver function test results, and pathology reports were analyzed. Non-parametric and receiver operating characteristic (ROC) tests for cut-off values were used. 

Results: Serum levels of total bilirubin (TB) and direct bilirubin (DB) after KPE were 10.9 mg/dL (6.6-22.3 mg/dL) and 8.6 mg/dL (5.1-16.1 mg/dL) for PPG, and 8.3 mg/dL (4.0-14.2 mg/dL) and 5.7 mg/dL (2.9-10.2 mg/dL) in GPG; both showed significant difference (p=0.004, p=0.003). The ROC analyses determined the optimal cut-off values were 8.84 mg/dL for TB with 75% sensitivity and 62% specificity; and 7.21 mg/dL for DB with 79% sensitivity and 65% specificity. Ductal plate malformation (DPM) was reported in 4 cases (29%) in GPG and in none of the cases of PPG (p = 0.047). 

Conclusion: Serum DB and TB levels early after KPE may be reliable early predictors of event-free survival. DPM may be a good prognostic factor, but larger case groups should be studied.

Keywords

• ductal plate malformation
• portoenterostomy
• bilirubin

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