Li Bingliang,Jin Yuanyuan,Wu Xiaoxia,et al.Laennec’s capsule-guided sharp-blunt dissection technique for hilar management during laparoscopic Kasai surgery for biliary atresia[J].Journal of Clinical Pediatric Surgery,2025,(11):1027-1031.[doi:10.3760/cma.j.cn101785-202507032-006]
腹腔镜Kasai手术中基于Laennec囊的锐性剪切联合钝性剥离的肝门处理技术初探
- Title:
- Laennec’s capsule-guided sharp-blunt dissection technique for hilar management during laparoscopic Kasai surgery for biliary atresia
- Keywords:
- Biliary Atresia; Portoenterostomy; Hepatic; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨基于解剖层隙的锐性剪切联合钝性剥离技术在小儿Ⅲ型胆道闭锁(biliary atresia,BA)腹腔镜Kasai手术中处理肝门纤维块的可行性和有效性。方法 回顾性分析山西省儿童医院2024年1月至2025年3月收治的10例Ⅲ型BA患儿临床资料,根据手术方式分为观察组和对照组。观察组5例,采用锐性剪切结合钝性剥离技术处理肝门纤维块;对照组5例,采用传统锐性剪切技术。观察指标包括手术日龄、手术时长、肝门纤维块清除时长、术中直接测量的肝门部切除面面积、术后恢复情况等。结果 观察组与对照组患儿术中肝门纤维块清除时间[(6.4±1.1)min比(12.2±1.9)min],差异有统计学意义(P<0.001)。两组手术时长、术中出血量、术后住院时间、术后3个月黄疸完全清除率、术后胆管炎发生率及随访期末自体肝生存状态差异无统计学意义(P>0.05)。术后随访3~18个月,患儿均获得自体肝生存。结论 在腹腔镜Kasai手术中,基于精确解剖层隙的肝门纤维块锐性剪切联合钝性剥离技术精准有效,能够一定程度上缩短关键操作环节的时间,有望获得理想的胆汁引流。
- Abstract:
- Objective To explore the feasibility and effectiveness of sharp shear plus blunt dissection technique based upon anatomical gap for hepatic hilar fibrous masses in pediatric type Ⅲ.biliary atresia (BA) laparoscopic Kasai surgery. Methods The relevant clinical data were retrospectively reviewed for 10 children hospitalized with type Ⅲ BA from January 2024 to March 2025.According to surgical approaches,they were assigned into study and control groups (n=5 each).Acute shear plus blunt peeling were employed in study group while traditional sharp shearing was adopted in control group.The major observation parameters included operative age,operative duration,hilar fiber block removal time,direct intraoperative measurement of hilar resection surface area and postoperative recovery. Results Significant inter-group difference existed in intraoperative clearance time of hilar fiber mass[(6.4±1.1) vs.(12.2±1.9)min](P<0.001).No significant inter-group differences existed in operative duration,intraoperative volume of blood loss,postoperative hospitalization stay,complete clearance of jaundice at Month 3 post-operation,count of postoperative cholangitis cases and autologous liver survival status at the end of follow-up period (P>0.05).Autologous liver survival was achieved during a postoperative follow-up period of (3-18) month. Conclusions During laparoscopic Kasai operation,the technique of "sharp shear plus blunt dissection" of hilar fiber block based upon precise anatomical gap is both accurate and effective.It may shorten the time of key procedures to a certain extent and btain ideal bile drainage.
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备注/Memo
收稿日期:2025-7-15。
基金项目:山西省卫健委课题(2022074);山西省儿童医院院级课题项目(2023002)
通讯作者:任红霞,Email:renhongxia100@sina.com