Zhang Jiayi,Li Jiamin,Liu Xingjian,et al.Retrospective analysis and treatment of mid/long-term complications after single-center laparoscopic radical resection of common bile duct cysts[J].Journal of Clinical Pediatric Surgery,2026,(03):227-231.[doi:10.3760/cma.j.cn101785-20251120-00072]
单中心腹腔镜胆总管囊肿根治术后中远期并发症的回顾性分析及治疗
- Title:
- Retrospective analysis and treatment of mid/long-term complications after single-center laparoscopic radical resection of common bile duct cysts
- 摘要:
- 目的 临床多见腹腔镜治疗胆总管囊肿术后围手术期并发症报道,中远期并发症报道少见,本文探讨腹腔镜治疗胆总管囊肿术后3个月中远期并发症的影响因素、处理策略以及预后情况。方法 回顾性分析2010年1月至2025年8月于山东大学齐鲁医院小儿外科接受腹腔镜胆总管囊肿根治术的319例患儿临床及随访资料,依据纳入与排除标准筛选病例,统计术后中远期并发症的发生率、类型、处理方式及预后。结果 排除失访及不符合纳入标准病例74例,最终纳入245例患儿。其中12例(4.9%)出现中远期并发症,具体如下:吻合口狭窄2例(0.8%),1例由肝右动脉骑跨所致,2例均经腹腔镜二次肝肠吻合术治愈;肝内胆管结石5例(2.0%),1例行ERCP取石后痊愈,其余4例行腹腔镜联合胆道镜取石,其中2例痊愈,1例残余少许2级胆管结石(无症状,保守观察至今),1例术后复发并于外院行肝部分切除术;门静脉海绵样变1例(0.4%),行Rex手术后好转;粘连性肠梗阻1例(0.4%),经保守治疗后好转。共出现胆管炎5例(2.0%),其中1例行保守抗炎治疗治愈,其余4例均合并上述结石并发症;肝功能异常10例(4.0%),其中2例无明确诱因、1例与胆管炎相关(均经保守治疗好转),其余7例与结构性并发症相关,分别合并结石(4例)、狭窄(2例)、门静脉海绵样变(1例),均经针对性治疗后好转。结论 腹腔镜胆总管囊肿患儿术后中远期并发症与手术技术、术前炎症程度、伴发畸形密切相关。建立完善的术后长期随访体系,早期识别并处理并发症可改善远期预后。
- Abstract:
- Objective While there are numerous reports on perioperative complications after laparoscopic treatment of choledochal cysts,reports on medium-and long-term complications are relatively scarce.This study was intended to explore the incidence,influencing factors,management strategies and outcomes of medium-and long-term complications at Month 3 after laparoscopy for choledochal cysts.Methods Retrospective analysis was conducted for the clinical and follow-up data of 319 children undergoing laparoscopic radical resection for choledochal cysts between January 2010 and August 2025.The incidence,types,managements and outcomes of medium-and long-term postoperative complications were statistically examined.And the findings were summarized along with the relevant literature.Results After excluding 74 cases due to losing to follow-up or failure to meet the inclusion criteria,245 cases were ultimately included.Among them,12 cases (4.9%) developed medium/long-term complications of anastomotic stenosis (n=2,0.8%).One case was caused by an overriding right hepatic artery.Both were cured by laparoscopic re-do hepaticojejunostomy.Intrahepatic choledocholithiasis occurred (n=5,2.0%); one was cured post-ERCP stone extraction while the other four underwent laparoscopy plus choledochoscopic stone removal.Of these four,two were cured and one had residual minor stones in secondary bile ducts (asymptomatic,under conservative observation to date).Another recurrent case subsequently underwent partial hepatectomy at another hospital.One case of portal cavernous transformation improved after Rex shunting.Another case of adhesive intestinal obstruction improved with conservative measures.And among 5 cases of cholangitis,one was cured with conservative anti-inflammatory therapy while the remainders were associated with the aforementioned stone-related complications.Liver function abnormalities were noted (n=10,4.0%); two had no clear cause and one was associated with concurrent cholangitis (all improved with conservative treatment),while the remaining seven were related to structural complications,including stone (n=4),stenosis (n=2) and portal cavernous transformation (n=1).All improved after targeted treatment.Conclusions Medium/long-term complications in children after laparoscopic choledochal cyst surgery are closely related to surgical techniques,degree of preoperative inflammation and associated malformations.Establishing a comprehensive long-term postoperative follow-up system and enabling early identification and management of complications can improve long-term outcomes.
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备注/Memo
收稿日期:2025-11-20。
基金项目:国家自然科学基金(82571975、82271743);山东大学齐鲁医学发展基金(34641390220001)
通讯作者:王东明,Email:wangdongming431x@163.com