Liu Fei,Xu Xiaogang,Zhu Deli,et al.Total laparoscopic congenital choledochal cyst excision in children: a clinical analysis of 10 cases[J].Journal of Clinical Pediatric Surgery,2019,18(07):563-567.[doi:10.3969/j.issn.1671-6353.2019.07.009]
完全腹腔镜治疗小儿先天性胆总管囊肿10例临床分析
- Title:
- Total laparoscopic congenital choledochal cyst excision in children: a clinical analysis of 10 cases
- Keywords:
- Laparoscopes; Choledochal Cyst
- 分类号:
- R726;R616.5;R575.7
- 摘要:
- 目的 初步探讨完全腹腔镜治疗小儿先天性胆总管囊肿的可行性及安全性。方法 回顾性分析广州市妇女儿童医疗中心2017年8月至2018年5月间10例于3D完全腹腔镜下行胆总管囊肿切除、肝总管空肠Roux-en-Y吻合术患儿的临床资料。其中男3例，女7例；Ⅰ型6例，Ⅳ型4例。随访7~16个月，通过患儿的手术资料、实验室检查结果及预后状况总结治疗经验。结果 10例均成功实施手术，平均手术时间（238±60）min，出血量5~10 mL。术后开始进食时间平均为（3.4±0.9）d，术后平均住院天数为（7.6±1.5）d。10例患儿术前ALT、AST、TBIL、DBIL、SAMY中位数分别为49.5 U/L、38.5 U/L、12.25 μmol/L、7.45 μmol/L、87.5 U/L，术后中位数分别为20 U/L、29.5 U/L、5.75 μmol/L、2.4 μmol/L、56.5 U/L，差异有统计学意义（P<0.05）。1例患儿术后1个月因胆支肠袢梗阻导致肠坏死，再次接受手术后痊愈，其余患儿均无吻合口狭窄、吻合口瘘、胆管炎、胰腺炎等并发症出现，全组无死亡病例。结论 完全腹腔镜治疗小儿先天性胆总管囊肿安全可行、效果良好，但手术难度相对较高。
- Abstract:
- Objective To explore the feasibility of total laparoscopic congenital chole-dochal cyst excision in children.Methods From August 2017 to May 2018,retrospective anal-yses were performed for 10 cases of three-dimensional (3D) total laparoscopic cyst excision for con-genital choledochal cyst during Roux-en-Y hepatoenterostomy.There were 3 boys and 7 girls.The clinical types were Ⅰ(n=6) and Ⅳ (n=4).Results Total laparoscopic cyst excision was completed successfully for 10 cases.The mean operative duration was (238±60) min,intraoperative bleeding volume 5 to 10 mL,average postoperative feeding time 3.4±0.9 days and mean hospitalization stay after initial operation 7.6±1.5 days.The follow-up period was 7 to 16 months.The median values of alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBIL),direct bili-rubin (DBIL) and serum amylase (SAMY) were 49.5 U/L,38.5 U/L,12.25 μmol/L,7.45 μmol/L and 87.5 U/L pre-operation and 20 U/L,29.5 U/L,5.75 μmol/L,2.4 μmol/L and 56.5 U/L post-operation respectively.The differences were statistically significant (P<0.05).One case was cured by reopera-tion after 1 month of initial surgery due to an obstruction of Roux jejunal loop.There was no onset of such complications as anastomotic stenosis,anastomotic fistula,cholangitis,pancreatitis or death.Conclusion Total laparoscopic congenital choledochal cyst excision is both safe and effective in children.However,operative difficulty is high.
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备注/Memo
收稿日期:2019-3-26。
基金项目:广州市妇女儿童医疗中心院内基金（编号：NO.IP-2018-008）
通讯作者:曾纪晓,Email:zengjixiao@163.com