Chang Xiaopan,Tang Shaotao,Cao Guoqing,et al.Laparoscopic widened-porta embedding anastomosis for choledochal cysts with a narrow portal bile duct[J].Journal of Clinical Pediatric Surgery,,18():552-558.[doi:10.3969/j.issn.1671-6353.2019.07.007]
Laparoscopic widened-porta embedding anastomosis for choledochal cysts with a narrow portal bile duct
- Keywords:
- Laparoscopes; Choledochal Cyst; Choledechojejunostomy
- CLC:
- R726;R616.5;R575.7
- Abstract:
- Objective To explore the laparoscopic widened-porta embedding anastomosis for preventing stricture in choledochal cysts(CCs) with a narrow hilar duct.Methods An anastomosis was created around the transected end of common bile duct in 12 minipigs(group A) while another 12 minipigs(group B) underwent conventional cholangiojejunostomy.Anastomotic diameter measurements and cholangiography were conducted at different timepoints.The expression levels of TGF-β1 and type I collagen were detected by real-time quantitative polymerase chain reaction(PCR).Between January 2012 and January 2018,laparoscopic excision of cyst and ductoplasty plus widened portoenterostomy were performed for 47 children with confirmed CCs with a narrow portal bile duct.The follow-up period was 15-83 months.Results Group A survived well without obstruction.Mild inflammation and fibrotic tissue were confined to bile duct periphery.In Group B,5 pigs developed stricture.Severe inflammation and diffuse fibrosis affected the whole layer of anastomosis.Fibrotic biomarkers were significantly higher postoperatively in Group B.Clinically,47 children exhibited satisfactory outcomes.The operative duration was(165±15) min and hospitalization length(9±2) days.No anastomotic stricture has been observed during a follow-up period of(31±18) months.Conclusion Laparoscopic widened-porta embedding anastomosis may be a superior option of preventing anastomotic stricture in CCs with an anastomosis <6 mm in diameter.
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Memo
收稿日期:2019-6-13。
基金项目:卫计委公益性行业科研专项（编号：201402007）
通讯作者:汤绍涛,Email:tshaotao83@126.com