Feng Yong,Zhou Chonggao,Xia Renpeng,et al.A comparative study of total laparoscopic versus open Kasai portoenterostomy for type Ⅲ biliary atresia[J].Journal of Clinical Pediatric Surgery,2025,(03):231-235.[doi:10.3760/cma.j.cn101785-202405073-006]
完全腹腔镜与开放Kasai手术治疗Ⅲ型胆道闭锁的对比研究
- Title:
- A comparative study of total laparoscopic versus open Kasai portoenterostomy for type Ⅲ biliary atresia
- Keywords:
- Laparoscopy; Biliary Atresia; Surgical Procedures; Operative; Child
- 摘要:
- 目的 对比分析完全腹腔镜与开放Kasai手术治疗婴儿Ⅲ型胆道闭锁的临床疗效。方法 回顾性分析2020年5月至2021年12月湖南省儿童医院14例完全腹腔镜Kasai手术(为完全腹腔镜组)与66例开放Kasai术胆道闭锁患儿(为开放组)的临床资料,对比分析两组患儿性别、手术日龄、体重、术前总胆红素、直接胆红素、谷丙转氨酶、谷氨酰转移酶(gamma-glutamyl transferase,GGT)、天门冬氨酸氨基转移酶与血小板比值(aspartate aminotransferase-to-platelet ratio index,APRI),手术时间、术中出血量、恢复进食时间、术后住院天数、术后并发症(胆瘘、肠瘘、肠梗阻、伤口裂开)及术后胆管炎发生率、早期胆管炎发生率、频发胆管炎发生率、黄疸清除率、1年及2年自体肝生存率(survival rate of native liver,SNL)、生存率等临床资料。结果 完全腹腔镜组与开放组相比,手术时间更长,差异有统计学意义(P<0.05);而出血量、恢复进食时间、术后住院时间、胆管炎发生率(71.4%比48.5%)、早期胆管炎发生率(28.6%比19.7%)、频发胆管炎发生率(14.3%比15.2%)、黄疸清除率(71.4%比69.7%)、1年SNL (57.1%比75.8%)、2年SNL (57.1%比71.2%)、1年生存率(78.6%比84.8%)及2年生存率(78.6%比81.8%)差异,均无统计学意义(P>0.05)。结论 完全腹腔镜Kasai手术治疗婴儿胆道闭锁安全、可行,与开放Kasai手术相比更加微创,而疗效无明显差异。
- Abstract:
- Objective To compare the efficacy of total laparoscopic versus open Kasai portoenterostomy for type Ⅲ biliary atresia (BA).Methods From May 2020 to December 2021,the relevant clinical data were retrospectively reviewed for 14 children undergoing laparoscopic Kasai portoenterostomy and 66 cases undergoing open Kasai portoenterostomy.Two groups were compared with regards to gender,operative age,body weight,preoperative total bilirubin,direct bilirubin,alanine aminotransferase,gamma-glutamyl transferase,aspartate aminotransferase-to-platelet ratio index,operative duration,volume of blood loss,time of feeding recovery,postoperative hospitalization stay,postoperative complications (biliary fistula,intestinal fistula,intestinal obstruction & wound dehiscence),postoperative cholangitis rate,early cholangitis rate,frequent cholangitis rate,jaundice clearance rate,1/2-year survival rate of native liver (SNL) and survival rate.Results There was statistically significant inter-group difference (P<0.05) in operative duration .No statistically significant difference (P>0.05) existed in volume of blood loss,time of feeding recovery,postoperative hospitalization stay,postoperative cholangitis rate (71.4% vs.48.5%),early cholangitis rate (28.6% vs.19.7%),frequent cholangitis rate (14.3% vs.15.2%),jaundice clearance rate (71.4% vs.69.7%),1-year SNL (57.1% vs.75.8%),2-year SNL (57.1% vs.71.2%),1-year survival rate (78.6% vs.84.8%) and 2-year survival rate (78.6% vs.81.8%).Conclusions Total laparoscopic Kasai portoenterostomy is safe,feasible and mini-invasive.Its outcomes are superior to those of open surgery.
参考文献/References:
[1] 中华医学会小儿外科学分会肝胆外科学组,中国医师协会器官移植医师分会儿童器官移植学组.胆道闭锁诊断及治疗指南(2018版)[J].中华小儿外科杂志,2019,40(5):392-398.DOI:10.3760/cma.j.issn.0253-3006.2019.05.003. Section of Hepatobiliary Surgery,Branch of Pediatric Surgery,Chinese Medical Association,Section of Pediatric Hepatic Transplantation,Branch of Organ Transplantation,Chinese Medical Doctor Association.Guidelines for diagnosing&treating biliary atresia (2018 edition)[J].Chin J Pediatr Surg,2019,40(5):392-398.DOI:10.3760/cma.j.issn.0253-3006.2019.05.003.
[2] Li B,Chen WB,Xia SL.A comparison of laparoscopic-modified kasai versus conventional open Kasai for biliary atresia in infants:a single-center experience[J].J Laparoendosc Adv Surg Tech A,2023,33(2):226-230.DOI:10.1089/lap.2022.0339.
[3] Hinojosa-Gonzalez DE,Bueno LC,Roblesgil-Medrano A,et al.Laparoscopic vs open portoenterostomy in biliary atresia:a systematic review and meta-analysis[J].Pediatr Surg Int,2021,37(11):1477-1487.DOI:10.1007/s00383-021-04964-5.
[4] Ji Y,Yang KY,Zhang XP,et al.The short-term outcome of modified laparoscopic Kasai portoenterostomy for biliary atresia[J].Surg Endosc,2021,35(3):1429-1434.DOI:10.1007/s00464-020-07530-7.
[5] 中华医学会小儿外科学分会肝胆外科学组.胆道闭锁Kasai术后胆管炎诊疗专家共识(2022版)[J].中华小儿外科杂志,2022,43(9):769-774.DOI:10.3760/cma.j.cn421158-20220427-00308. Section of Hepatobiliary Surgery,Branch of Pediatric Surgery,Chinese Medical Association.Expert consensus on diagnosing and treating cholangitis after Kasai operation for biliary atresia (2022 edition)[J].Chin J Pediatr Surg,2022,43(9):769-774.DOI:10.3760/cma.j.cn421158-20220427-00308.
[6] 钟浩宇,刘雪来,黄格元.关于胆道闭锁Kasai手术的若干问题[J].临床小儿外科杂志,2016,15(1):4-6.DOI:10.3969/j.issn.1671-6353.2016.01.002. Zhong HY,Liu XL,Huang GY.Miscellaneous issues regarding Kasai surgery for biliary atresia[J].DOI:10.3969/j.issn.1671-6353.2016.01.002.
[7] 王艺曦,陈军泽,张诚,等.腹腔镜Kasai手术在Ⅲ型胆道闭锁中的临床应用评价[J].临床小儿外科杂志,2021,20(4):340-347.DOI:10.12260/lcxewkzz.2021.04.008. Wang YX,Chen JZ,Zhang C,et al.Clinical evaluations of laparoscopic Kasai portoenterostomy for type Ⅲ biliary atresia[J].J Clin Ped Sur,2021,20(4):340-347.DOI:10.12260/lcxewkzz.2021.04.008.
[8] Esteves E,Clemente Neto E,Ottaiano Neto M,et al.Laparoscopic Kasai portoenterostomy for biliary atresia[J].Pediatr Surg Int,2002,18(8):737-740.DOI:10.1007/s00383-002-0791-6.
[9] Lishuang M,Zhen C,Guoliang Q,et al.Laparoscopic portoenterostomy versus open portoenterostomy for the treatment of biliary atresia:a systematic review and meta-analysis of comparative studies[J].Pediatr Surg Int,2015,31(3):261-269.DOI:10.1007/s00383-015-3662-7.
[10] Hussain MH,Alizai N,Patel B.Outcomes of laparoscopic Kasai portoenterostomy for biliary atresia:a systematic review[J].J Pediatr Surg,2017,52(2):264-267.DOI:10.1016/j.jpedsurg.2016.11.022.
[11] Li ZH,Ye YQ,Wu ZG,et al.Learning curve analysis of laparoscopic Kasai portoenterostomy[J].J Laparoendosc Adv Surg Tech A,2017,27(9):979-982.DOI:10.1089/lap.2016.0204.
[12] Ji Y,Yang KY,Zhang XP,et al.Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia:report of 100 cases[J].BMC Surg,2018,18(1):107.DOI:10.1186/s12893-018-0443-y.
[13] Wang SQ,Hu XT,Wang J.Learning curve of laparoscopic Kasai portoenterostomy in a tertiary hospital with low caseload of biliary atresia[J].J Laparoendosc Adv Surg Tech A,2022,32(4):442-447.DOI:10.1089/lap.2021.0653.
[14] Okur MH,Aydo?du B,Azizo?lu M,et al.Laparoscopic versus open portoenterostomy for treatment of biliary atresia:a meta-analysis[J].Pediatr Surg Int,2023,39(1):148.DOI:10.1007/s00383-023-05436-8.
[15] Son TN,Mai DV,Tung PT,et al.Laparoscopic versus open Kasai procedure for biliary atresia:long-term results of a randomized clinical trial[J].Pediatr Surg Int,2023,39(1):111.DOI:10.1007/s00383-023-05391-4.
[16] Sun X,Diao M,Wu XZ,et al.A prospective study comparing laparoscopic and conventional Kasai portoenterostomy in children with biliary atresia[J].J Pediatr Surg,2016,51(3):374-378.DOI:10.1016/j.jpedsurg.2015.10.045.
[17] Shirota C,Murase N,Tanaka Y,et al.Laparoscopic Kasai portoenterostomy is advantageous over open Kasai portoenterostomy in subsequent liver transplantation[J].Surg Endosc,2020,34(8):3375-3381.DOI:10.1007/s00464-019-07108-y.
[18] Li YN,Gan JR,Wang C,et al.Comparison of laparoscopic portoenterostomy and open portoenterostomy for the treatment of biliary atresia[J].Surg Endosc,2019,33(10):3143-3152.DOI:10.1007/s00464-019-06905-9.
[19] Murase N,Hinoki A,Shirota C,et al.Multicenter,retrospective,comparative study of laparoscopic and open Kasai portoenterostomy in children with biliary atresia from Japanese high-volume centers[J].J Hepatobiliary Pancreat Sci,2019,26(1):43-50.DOI:10.1002/jhbp.594.
[20] Liu F,Xu XG,Liang ZJ,et al.Early bile drainage improves native liver survival in biliary atresia without cholangitis[J].Front Pediatr,2023,11:1189792.DOI:10.3389/fped.2023.1189792.
[21] 王磊,兰照平,高琪,等.胆道闭锁患儿Kasai手术后胆管炎的危险因素分析[J].临床小儿外科杂志,2023,22(11):1039-1044.DOI:10.3760/cma.j.cn101785-202211061-007. Wang L,Lan ZP,Gao Q,et al.Analysis of risk factors for cholangitis after Kasai procedure in biliary atresia children[J].J Clin Ped Sur,2023,22(11):1039-1044.DOI:10.3760/cma.j.cn101785-202211061-007.
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备注/Memo
收稿日期:2024-5-28。
基金项目:国家临床重点专科重大科研专项(Z20230059);湖南省出生缺陷协同防治科技重大专项(2019SK1010);湖南省自然科学基金(2025JJ50672)
通讯作者:周崇高,Email:zhouchonggao@sina.com