改良Warren胆肠吻合术治疗儿童胆总管囊肿91例临床回顾分析  

Modified biliary-enteric loop type anastomosis for congenital choledochal cyst： a retrospective study of 91 cases

作　　者：陈吉[1] 杜宝峰[1] 易军[1] 姜斌[1] 盛玉[1] 杨振华[1] 李涛[1] 孙斌[1] 黄磊[1] 孙梦娇[2] 

机构地区：[1]南京医科大学附属南京儿童医院普外科,210008 [2]南京医科大学附属南京儿童医院血液肿瘤科,210008

出　　处：《中华小儿外科杂志》2016年第6期440-443,共4页Chinese Journal of Pediatric Surgery

基　　金：南京市卫生局基金项目（YKK14114）;南京医科大学面上基金项目（2014NJMU155）

摘　　要：目的探讨改良Warren胆肠吻合术治疗儿童胆总管囊肿的经验及疗效。方法回顾性分析2009年1月至2013年12月采用改良Warren胆肠吻合术治疗91例胆总管囊肿的临床资料，并于术后对患儿进行长期门诊随访。本组患儿发病年龄为6～145月龄，首发临床表现为腹痛、黄疸、便白等。所有患儿术前行B型超声、腹部CT、MRCP等检查。Todani分型：I型69例，Ⅳ型22例。结果91例患儿平均手术时间为（129．34±23．50）min，术后平均肠鸣音恢复时间为（26．51±4．13）h，术后平均禁食时间为（5．47±0．77）d，术后平均住院时间为（11．84±2．58）d。术后短期内共发生肠梗阻1例，胰腺炎1例，胆漏3例。肠梗阻1例阻行再次手术治疗，胆漏3例及胰腺炎1例行保守治疗恢复良好。经7个月--5年随访，4例患儿存在偶发腹痛，相关检查排除器质性病变。上消化道造影检查提示3例患儿存在造影剂反流现象，但均无临床表现。营养评估表明所有患儿术后生长发育良好。结论我院实施的改良Warren胆肠吻合术治疗儿童胆总管囊肿术式安全可靠，过程相对简单，术中及术后并发症少，治疗效果明显。Objective To evaluate the efficacies of modified biliary-enteric loop type （Warren＇ s） anastomosis of congenital choledochal cyst （CC） in children. Methods From January 2009 to December 2013, a total of 91 CC children were enrolled. Their clinical manifestations included abdominal pain, jaundice and white stool, etc. There were 19 males and 72 females with an age range of 6 145 months. The Todani types of CC were type I （n = 69） and typeIg （n = 22） according to the diagnostic criteria of ultrasound type B, abdominal computed tomography （CT） and magnetic resonance cholangiopancreatography. Results The average operative duration was （129. 34±23.50） mins. The initial flatus time was （26. 51 ±4.13） hours and the time to resume eating was （5.47 ±0. 77） days. The average length of postoperative hospital stay was （11. 84 ±2. 58） days. Postoperative complications included intestinal obstruction （n = 1）, postoperative pancreatitis （n = 1） and bile leakage （n= 3）. One case of intestinal obstruction necessitated re-explorati0n. And 4 cases of bile leakage or postoperative pancreatitis were cured by conservative measures. During a follow-up period of 7-60 months, 4 cases of occasional abdominal pain had no underlying organic illness. Three asymptomatic cases had contrast agent refluxing on upper gastrointestinal imaging. According to nutritional assessments, all children were of good nutrition. Conclusions Modified biliary-enterie loop type anastomosis is safe, simple and reliable for CC. However, a long follow-up period with a large sample size is necessary for confirming its long-term efficacies.

关 键 词：胆总管囊肿 吻合术 外科 随访研究 

分 类 号：R726.5[医药卫生—儿科]