■肝外胆道闭锁(BA)见于婴儿,发病率为15,000名活产儿中的1名。表现为进行性黄疸,深色尿液,和粘土色的凳子。Kasai门肠造口术(KPE)是这些患者的常用外科手术。术后,苯巴比妥,熊去氧胆酸(UDCA),类固醇,和其他药物用于改善胆汁引流,预防炎症和纤维化。然而,关于不同药物需求的明确协议,剂量,和持续时间因个别外科医生和中心而异。KPE术后处理没有普遍接受的方案。
■这项研究的目的是了解主题专家对BA的普遍术后管理,并使用Delphi过程来了解专家是否希望根据调查结果改变他们的做法。
■在与BA领域的两位专家讨论后,进行了问卷调查。问卷已邮寄给25位主题专家。分析了第一次调查数据,并与所有响应者共享。在第二次调查中,根据第一次调查结果评估了管理层的变化。
■17位专家回答了德尔菲问卷。术后,约40%的受访者使用预防性抗生素6-12周,30%的受访者使用抗生素>12周。苯巴比妥的处方为<3个月,近50%。UDCA规定<3个月,≤6个月,6个月-1年增长47.1%,23.5%,和23.5%的响应者,分别。近50%的处方类固醇(主要是泼尼松龙),其中,三分之二的人开出6-12周的处方。大约60%的儿童给予巨细胞病毒免疫球蛋白M阳性的抗病毒药物。在我们的调查中,50%的专家每年执行5-10KPE,25%的人每年执行10-15和>15KPE。第二项调查指出,相当比例的响应者希望根据共识改变他们的做法。
■根据我们的德尔福调查,可以概述BA的术后管理。然而,对于BA术后管理的统一方案,需要进行多中心研究。
UNASSIGNED: Extrahepatic biliary atresia (BA) is seen in infants, with an incidence of 1 in 15,000 live births. The presentation is progressive jaundice, dark-colored urine, and clay-colored stools. Kasai portoenterostomy (KPE) is the commonly performed surgical procedure in these patients. Postoperatively, phenobarbitone, ursodeoxycholic acid (UDCA),
steroids, and other drugs are given to improve bile drainage and prevent inflammation and fibrosis. However, a definitive protocol regarding the need for different drugs, dosage, and duration varies across individual surgeons and centers. No universally accepted protocol exists for postoperative management after KPE.
UNASSIGNED: The aim of this study was to know the prevailing postoperative management of BA by subject experts and use the Delphi process to know if the experts want to change their practice based on the results from the survey.
UNASSIGNED: A questionnaire was made after discussing with two experts in the field of BA. The questionnaire was mailed to 25 subject experts. The first survey data were analyzed and shared with all responders. In the second survey, change in the management based on the results from the first survey was assessed.
UNASSIGNED: The Delphi questionnaire was answered by 17 experts. Postoperatively, prophylactic antibiotics are prescribed for 6-12 weeks by around 40% and >12 weeks by 30% of respondents. Phenobarbitone is prescribed for <3 months by nearly 50%. UDCA is prescribed for <3 months, ≤6 months, and 6 months-1 year by 47.1%, 23.5%, and 23.5% responders, respectively. Nearly 50% prescribe
steroids (mostly prednisolone), and among them, two-thirds prescribe it for 6-12 weeks. Approximately 60% give antiviral drugs to children who are cytomegalovirus immunoglobulin M positive. In our survey, 50% of experts perform 5-10 KPE per year, and 25% each perform 10-15 and >15 KPE per year. The second survey noted that a significant percentage of responders want to change their practice according to
consensus.
UNASSIGNED: From our Delphi survey, an overview of the postoperative management of BA could be made. However, multicentric studies are required for uniform protocol on the postoperative management of BA.