Xu Zhongya,Du Baofeng,Yi Jun,et al.Comparative Study on laparoscopic or laparotomy total cyst excision in treating congenital choledochalcyst[J].Journal of Clinical Pediatric Surgery,2018,17(09):692-698.
腹腔镜辅助与开腹手术治疗先天性胆总管囊肿的对比研究
- Title:
- Comparative Study on laparoscopic or laparotomy total cyst excision in treating congenital choledochalcyst
- Keywords:
- Laparoscopic total cyst excision; Laparotomic total cyst excision; Choledochal cyst; Growth and development; Psychological behaviors
- 文献标志码:
- A
- 摘要:
- 目的 通过回顾性分析，比较开腹手术与腹腔镜辅助手术治疗胆总管囊肿在围手术期指标、术后并发症、对患儿生长发育和心理行为的影响等方面的差异，分析两种手术的优劣，为先天性胆总管囊肿的的治疗决策提供参考。 方法 选取2005年7月1日至2015年7月1日在本院行腹腔镜辅助下胆总管囊肿根治术的患儿46例（腹腔镜手术组），行开腹手术的患儿80例（开腹手术组），比较两组患儿围手术期情况及术后近远期并发症情况。对术后随访达5年的患儿进行复查，其中26例行腹腔镜辅助下胆总管囊肿根治术，40例行开腹手术，比较两组患儿生长发育和心理行为情况。结果 围手术期，腹腔镜手术组在术中出血、肠道功能恢复时间、白细胞计数、CRP恢复水平、住院时间上均优于开腹手术组（P < 0.05），而两组胃肠减压管、腹腔引流管的拔管时间比较差异均无统计学意义（P > 0.05）。不同手术方式患儿出院后血生化指标（AST、ALT、总蛋白、总胆红素）无明显统计学差异（P > 0.05）。腹腔镜手术组出现发热5例，不全性肠梗阻1例，胆瘘1例；开腹手术组发热7例，不全性肠梗阻2例，胆瘘2例，活动性出血1例，两组患儿近期并发症的发生率无统计学差异（P > 0.05）。随访生长发育指标无明显统计学差异。腹腔镜手术组、开腹手术组心理测评得分均在正常范围，但开腹手术组心理测评得分低于腹腔镜手术组。结论 腹腔镜辅助下胆总管囊肿根治手术患儿术中出血少，手术切口小，愈合快，住院时间短，较开腹手术有一定的优势。两种手术方式对术后患儿生长发育的影响无统计学差别，远期心理影响有待进一步深入研究。
- Abstract:
- Objective To study the psychological situations、growth and development of children underwent laparoscopic or laparotomic total cyst excision over the past decade. Methods From July 1, 2005 to July 1, 2015, a total of 126 children with choledocho cyst underwent laparoscopic (A, n=46) and laparotomic (B, n=80) total cyst excision. Retrospective analysis was performed for perioperative profiles of two groups. The follow-up period was 5 years. Results During perioperative period, laparoscopy was superior to laparotomy in terms of intraoperative bleeding , recovery time of intestional function, white blood cell count, restoring level of C-reactive protein and hospitalization length(P < 0.05). Yet two groups had no statistical differences in removal durations of gastrointestinal decompression and abdominal irrigation tubes (P > 0.05). And no obvious statistical differences existed in the post-discharge levels of biochemical parameters (aspartate aminotransferase, alanine aminotransferase, total protein and total bilirubin) (P > 0.05). In laparoscopic group, there were fever (n=5), incomplete intestinal obstruction (n=1) and biliary fistula (n=1); in laparotomic group, fever (n=7), incomplete intestinal obstruction (n=2), biliary fistula (n=2) and active bleeding (n=1). No inter-group statistical difference existed in immediate complications (P > 0.05) Conclusion The advantages of laparoscopic versus laparotomic total cyst excision include minimal bleeding, smaller incision, faster healing and shorter postoperative hospital day. No significant inter-group difference exists in growth and development. The long-term psychological impact requires further studies.
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