Wang Xinning,Li Suolin,Liu Xuelai,et al.Different laparoscopically assisted biliary reconstructions for congenital choledochal cyst[J].Journal of Clinical Pediatric Surgery,,18():559-562.[doi:10.3969/j.issn.1671-6353.2019.07.008]
Different laparoscopically assisted biliary reconstructions for congenital choledochal cyst
- CLC:
- R726;R616.5;R575.7
- Abstract:
- Objective To evaluate the effectiveness of different laparoscopic biliary tract reconstructions after congenital choledochal cyst(CCC) excision involving Roux-en-Y hepaticojejunostomy(RY group),modified Warren loop hepaticojejunostomy(MW group) and hepaticoduodenostomy(HD group).Methods A total of 112 CCC children undertook laparoscopic resection of extrahepatic bile ducts plus RY(n=49),MW(n=31) and HD(n=32) anastomosis respectively.Their clinical data were retrospectively summarized and analyzed,including perioperative parameters,complications and ultrasonographic follow-ups.Results Laparoscopic choledochal cyst resection and biliary-enteric reconstruction were completed successfully in all patients.There was no intraoperative accident or any conversion into open surgery.The operative duration was(186.10±19.23) min in RY group,(149.81±23.37) min in MW group and(134.68±21.36) min in HD group(P<0.05).The recovery time of intestinal motility was(2.07±1.27) days in RY group,(1.05±0.97) days in HJ group and(1.02±1.14) days in HD group(P<0.05).Estimated blood loss,abdominal drainage tube time,perioperative complications and hospital stay were not different among three groups(P>0.05).Intrahepatic reflux(37.5%) was detected by ultrasonography and type IV cases with anastomotic stenosis underwent balloon dilatation in HD group.Conclusion Three biliary-enteric reconstructive procedures have both advantages and disadvantages.Roux-en-Y anastomosis is more suitable for hepatic portal biliary duct plasty.Jejunum is spared in MW so that much time is saved and normal electrophysiological rhythm preserved.It promotes recovery of postoperative intestinal peristalsis.HD anastomosis can be successfully completed under guidance of laparoscope,yet there is a higher incidence of postoperative complications.Personalized biliary-enteric reconstruction should be adopted according to different types of biliary dilation.
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Memo
收稿日期:2019-5-16。
基金项目:国家卫生健康委员会公益性行业科研专项（编号：201402007）
通讯作者:李索林,Email:lisuolin@263.net