Tao Boyuan,Zhong Zhizu,Zeng Jixiao,et al.Clinical comparison of transumbilical single-port laparoscopic versus conventional four-port laparoscopic treatment of pediatric choledochal cyst[J].Journal of Clinical Pediatric Surgery,2025,(04):331-338.[doi:10.3760/cma.j.cn101785-202307044-006]
经脐单孔与传统四孔法腹腔镜手术治疗儿童胆总管囊肿的对比研究
- Title:
- Clinical comparison of transumbilical single-port laparoscopic versus conventional four-port laparoscopic treatment of pediatric choledochal cyst
- Keywords:
- Choledochal Cyst; Surgical Procedures; Operative; Methods; Laparoscopy; Treatment Outcome; Comparative Study; Child
- 摘要:
- 目的 比较经脐单孔与传统四孔法腹腔镜手术治疗儿童胆总管囊肿的临床疗效。方法 本研究为回顾性研究。2019年6月至2022年12月广州医科大学附属妇女儿童医疗中心胃肠外科收治的胆总管囊肿患儿87例,按照纳入排除标准选取其中85例作为研究对象,根据手术方式分为经脐单孔腹腔镜组(单孔组)44例、传统四孔法腹腔镜组(多孔组)41例。比较两组患儿基线资料、手术情况以及治疗效果。结果 两组均顺利完成手术。多孔组与单孔组相比,男女性别比例(11/30比10/34,χ2=0.192,P=0.661)、手术年龄、术中出血量、引流管放置率、肠功能恢复时间、术后住院时间、并发症发生率差异均无统计学意义(P＞0.05);而手术时间、术后24 h疼痛评分、切口满意度评分差异均有统计学意义(P＜0.05)。单孔组中1例术后出现胆漏,经腹腔引流12 d后痊愈;多孔组中1例发生术后出血,急行腹腔镜探查发现为囊肿分离面出血,经止血处理后顺利恢复。随访6~48个月,两组均治愈,无一例吻合口狭窄、胆管炎、胰腺炎、肠梗阻或死亡病例出现。结论 经脐单孔腹腔镜手术治疗儿童胆总管囊肿的近中期疗效与传统四孔法腹腔镜手术相似。前者具有切口美容效果好、术后疼痛轻等优点,但手术难度较高,手术时间较长,对于术前存在反复胆道感染、影像学检查提示需要术中行胆管成形的患儿,建议谨慎开展该手术。
- Abstract:
- Objective To compare clinical application value of transumbilical single-port laparoscopic hepaticojejunostomy (TUSPLH) versus conventional four-port laparoscopic hepaticojejunostomy (CLH) for children with choledochal cyst using conventional laparoscopic instruments.Methods From June 2019 to December 2022,87 children with choledochal cyst were hospitalized.According to the inclusion criteria,the clinical data of 85 children were retrospectively reviewed.Forty-four children underwent TUSPLH while another 41 children CLH.Baseline profiles,operative findings and curative outcomes were compared between two groups.Results All operation were successfully completed.Age,volume of blood loss,drainage tubing rate,intestinal function recovery time,postoperative hospital stay and complication rate showed no significant inter-group difference.The inter-group differences in operative duration,pain score and incision healing satisfaction score differed significantly.One child in TUSPLH group experienced postoperative bile leakage and healed after 12-day abdominal drainage.Another child in CLH group had postoperative hemorrhage.Emergency laparoscopic exploration revealed hemorrhage of cyst separation surface.After surgical hemostasis,the child recovered smoothly.The remainders had no onset of such complications as anastomotic stenosis,cholangitis or pancreatitis.No mortality occurred in neither groups.Conclusions For pediatric choledochal cyst,both TUSPLH and CLH with conventional laparoscopic instruments may achieve similar short/middle-term outcomes.The former offers a satisfactory cosmetic incision and milder postoperative pain.However,there are greater surgical difficulty and longer operative duration.For recurrent preoperative biliary tract infections and imaging findings necessitating intraoperative cholangioplasty,TUSPLH should be performed with more caution.
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备注/Memo
收稿日期:2023-7-22。
基金项目:国家自然科学基金(82170528);广东省自然科学基金(2022A1515012254);广州市科技计划市校(院)联合资助项目(202201020612);广州市临床特色技术项目(2023C-TS48)
通讯作者:曾纪晓,Email:zengjixiao@163.com