Atresia biliar: continuamos operando tarde / Biliary atresia: we still operate too late
J. pediatr. (Rio J.)
; 84(5): 436-441, set.-out. 2008. graf, tab
Article
Dans En, Pt
| LILACS
| ID: lil-496634
Responsable en Bibliothèque :
BR1.1
RESUMO
OBJETIVO:
Analisar a idade na cirurgia de crianças com atresia biliar e a sobrevida sem necessidade de transplante de fígado. O estudo foi realizado no Hospital de Clínicas de Porto Alegre.MÉTODOS:
Foram revisados os prontuários dos pacientes operados entre 1982 e 2007, residentes no Rio Grande do Sul.RESULTADOS:
Dos 112 casos estudados de crianças com atresia biliar, 38 (33,9 por cento) ocorreram de 1982 a 1989, 46 (41,1 por cento) de 1990 a 1999 e 28 (25,0 por cento) a partir de 2000. Em 12 (10,7 por cento) casos, não foi realizada a portoenterostomia. A idade na cirurgia variou de 25 a 297 dias (mediana 80,5; IIQ25-75 61,3-109,0 dias); em 20,5 por cento dos casos, a idade das crianças foi menor do que 60 dias. Não houve diferença na idade, no momento do diagnóstico, entre as 3 décadas. Os pacientes do interior do estado (mediana 87,0; IIQ25-75 69,0-115,0 dias) foram encaminhados significativamente (p = 0,007) mais tarde do que os da região metropolitana de Porto Alegre (RS) (mediana 68,0; IIQ25-75 55,5-98,0 dias). A proporção de pacientes com menos de 60 dias foi significativamente menor (p = 0,013) nos oriundos do interior. A sobrevida com fígado nativo do total dos pacientes foi de 46,2 por cento em 2 anos, diminuindo progressivamente até 15,3 por cento em 20 anos. Os pacientes operados com menos de 60 dias tiveram maior sobrevida com fígado nativo (log rank < 0,0001).CONCLUSÕES:
A portoenterostomia se manteve tardia nos últimos 25 anos, e esse atraso determinou menor tempo de sobrevida com fígado nativo nos pacientes com atresia biliar.ABSTRACT
OBJECTIVE:
To analyze the age at surgery for children with biliary atresia and their survival periods without need for liver transplantation. The study was performed at Hospital de Clínicas de Porto Alegre, in Porto Alegre, state of Rio Grande do Sul, Brazil.METHODS:
The medical records of patients operated between 1982 and 2007 who were residents of the state of Rio Grande do Sul were reviewed.RESULTS:
Of the 112 cases of children with biliary atresia studied, 38 (33.9 percent) occurred between 1982 and 1989, 46 (41.1 percent) between 1990 and 1999 and 28 (25.0 percent) after 2000. Portoenterostomy was not performed for 12 cases (10.7 percent). Age at surgery ranged from 25 to 297 days (median 80.5; IQR25-75 61.3-109.0 days); for 20.5 percent of cases, the age was below 60 days. There was no age difference at diagnosis for the three decades in the study. Patients from the countryside (median 87.0; IQR25-75 69.0-115.0 days) were referred significantly later (p = 0.007) than those living in Porto Alegre and the metropolitan area (median 68.0; IQR25-75 55.5-98.0 days). The ratio of patients younger than 60 days was significantly lower (p = 0.013) for those from the countryside. Survival periods with native liver for all patients was 46.2 percent in 2 years, falling continuously until reaching 15.3 percent in 20 years. Patients operated before reaching 60 days of age had longer survival periods with native livers (log rank < 0.0001).CONCLUSIONS:
Late performance of portoenterostomy was a constant in the past 25 years, and this delay led to shorter survival periods with native livers for biliary atresia patients.
Texte intégral:
1
Indice:
LILACS
Sujet Principal:
Atrésie des voies biliaires
/
Hépato-porto-entérostomie
/
Transplantation hépatique
Type d'étude:
Prognostic_studies
Limites du sujet:
Female
/
Humans
/
Infant
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Male
/
Newborn
langue:
En
/
Pt
Texte intégral:
J. pediatr. (Rio J.)
Thème du journal:
PEDIATRIA
Année:
2008
Type:
Article