Zhu Xiaomin,Shi Yingzuo,Fang Zhihong,et al.Treatment of choledochal cyst by laparoscopy plus fibrocholedochoscopy versus traditional laparoscopy[J].Journal of Clinical Pediatric Surgery,2024,(07):659-664.[doi:10.3760/cma.j.cn101785-202212045-010]
腹腔镜联合纤维胆道镜与传统腹腔镜治疗胆总管囊肿的研究
- Title:
- Treatment of choledochal cyst by laparoscopy plus fibrocholedochoscopy versus traditional laparoscopy
- Keywords:
- Congenital Choledochal Cyst; Laparoscopy; Choledochoscopy; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨腹腔镜联合纤维胆道镜与传统腹腔镜治疗胆总管囊肿的效果。方法 本研究为回顾性研究,选取无锡市儿童医院40例胆总管囊肿患儿作为研究对象,根据手术方案分为观察组(n=20)、对照组(n=20)。对照组采用腹腔镜胆总管囊肿根治术,观察组采用腹腔镜联合纤维胆道镜胆总管囊肿根治术。记录两组手术时间、蛋白栓检出率、蛋白栓一次性清除率、中转开腹情况、并发症以及术前、术后1 d及术后3 d内环境指标变化、术后康复情况(全量肠内营养时间、肛门排气时间、住院时间)。结果 观察组与对照组手术时间比较,差异有统计学意义(P＜0.05)。观察组蛋白栓检出率为65.00%(13/20),对照组蛋白栓检出率为60.00%(12/20);观察组蛋白栓一次性清除率为100.00%(13/13),对照组蛋白栓一次性清除率为83.33%(10/12);观察组并发症发生率为0(0/20),对照组并发症发生率为20.00%(4/20);以上3项指标组间差异均无统计学意义(P＞0.05)。观察组、对照组术后1 d与术前比较,FT3水平均明显降低,Cor以及ACTH水平均明显升高(P＜0.05)。观察组、对照组术后3 d与术后1 d比较,FT3水平显著升高,Cor以及ACTH水平均明显降低(P＜0.05)。对照组术后3 d 与术前比较,FT3水平明显降低,Cor、ACTH水平明显升高(P＜0.05);术后3 d观察组与对照组比较,上述指标组间差异均无统计学意义(P＞0.05)。观察组与对照组全量肠内营养时间、肛门排气时间[(24.31±3.18)h比(26.49±3.40)h]、住院时间比较,差异有统计学意义(P＜0.05)。结论 与传统腹腔镜手术相比,腹腔镜联合纤维胆道镜胆总管囊肿根治术应用于小儿胆总管囊肿,可确保蛋白栓的有效检出及一次性清除,对患儿内环境影响更小,安全性更高。
- Abstract:
- Objective To explore the efficacy of laparoscopy plus fibrocholedochoscopy versus traditional laparoscopy for choledochocyst in children.Methods A retrospective study was performed for 40 children with choledochal cyst.According to different surgical protocols,they were assigned into two groups of observation (n=20) and control (n=20).Control group underwent laparoscopic resection of choledochal cyst while observation group had laparoscopy plus fiberoptic choledochoscopy radical resection of choledochal cyst.Operative duration,protein plug detection rate,one-time clearance rate,need for a conversion into open surgery,complications,changes in internal environment parameters preoperatively,1/3 day postoperatively,as well as postoperative recovery status (time to full enteral nutrition,time to anal exhaust & length of hospitalization stay).Results Operative duration was (227.80±39.74) min in observation group and (189.50±5.92) min in control group.There was statistically significant inter-group difference (P＜0.05).Detection rate of protein plugs was 65.00%(13/20) in observation group and 60.00%(12/20) in control group.There was no statistically significant inter-group difference (P>0.05).One-time clearance rate was 100.00%(13/13) in observation group and 83.33%(10/12) in control group.There was no statistically significant inter-group difference (P>0.05).Comparing Day 1 post-operation with pre-operation,FT3 level declined while the levels of Cor and ACTH spiked (P<0.05).Comparing Day 1/3 post-operation,FT3level rose while the levels of Cor μg/L and ACTH [(18.42±4.02) vs.(33.67±6.72),(19.88±4.53) vs.(38.19±7.04) ng/L]dropped (P<0.05).Comparing Day 3 post-operation with pre-operation,FT3 level declined while the levels of Cor and ACTHjumped (P<0.05).Comparing Day 3 post-operation with control group,there was no statistically significant inter-group difference (P>0.05).Comparing observation and control groups,full enteral nutrition time ,anal exhaust timeand hospitalization stayhad statistically significant differences (P<0.05).Conclusions As compared with traditional laparoscopy,laparoscopy plus choledochal cyst radical operation are more efficacious for choledochal cyst in children.While ensuring the detection rate of protein thrombin and one-time clearance rate,it has less impact on internal environment of children with an excellent safety.
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备注/Memo
收稿日期:2022-12-27。
基金项目:无锡市科技资金发展项目(Y20212033)
通讯作者:石英佐,Email:954100253@qq.com