腹腔镜扩大肝门埋入空肠吻合术治疗上端开口过小胆总管囊肿的可行性和有效性探讨  

Laparoscopic widened-porta embedding anastomosis for choledochal cysts with a narrow portal bile duct

作　　者：常晓盼 汤绍涛[1] 曹国庆[1] 李帅[1] 张茜 Chang Xiaopan;Tang Shaotao;Cao Guoqing;Li Shuai;Zhang Qian(Department of Pediatric Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science & Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院小儿外科

出　　处：《临床小儿外科杂志》2019年第7期552-558,共7页Journal of Clinical Pediatric Surgery

基　　金：卫计委公益性行业科研专项(编号:201402007)

摘　　要：目的通过动物实验和病例观察两方面的结果探讨腹腔镜扩大肝门埋入空肠吻合术预防吻合口狭窄的可行性和有效性。方法动物实验部分遵循相关的实验设计原则,构建巴马小型猪模型,并将其随机分为2组接受不同的干预方案。两组胆总管直径均<6mm。A组(n=12)行胆总管套入式吻合,模拟肝门包入空肠吻合术;B组(n=12)行胆总管空肠吻合,模拟经典肝管空肠吻合术;比较两组吻合口局部组织学特点。病例观察部分选取2012年1月至2018年1月于华中科技大学同济医学院附属协和医院小儿外科接受腹腔镜肝门扩大埋入空肠吻合术的肝门胆管狭窄胆总管囊肿患儿47例并进行随访,初步总结手术治疗经验。结果A组实验动物术后无一例发生吻合口狭窄,B组中有5只小型猪出现狭窄;B组狭窄吻合口组织表现为炎性细胞浸润严重、粗大的胶原纤维排列紊乱以及遍布吻合口全层,促纤维化因子表达水平较A组显著增高(P<0.05)。47例患儿腹腔镜肝门扩大埋入空肠吻合手术过程均顺利,手术时长(165±15)min,住院时间(9±2)d。随访(31±18)个月,无一例并发胆管炎、胆管结石及吻合口狭窄。结论对于肝门胆管直径<6mm的胆总管囊肿,腹腔镜肝门扩大埋入空肠吻合术能有效地预防术后吻合口狭窄的发生。Objective To explore the laparoscopic widened-porta embedding anastomosis for preventing stricture in choledochal cysts(CCs)with a narrow hilar duct. Methods An anastomosis was created around the transected end of common bile duct in 12 minipigs(group A)while another 12 minipigs(group B)underwent conventional cholangiojejunostomy.Anastomotic diameter measurements and cholangiography were conducted at different timepoints.The expression levels of TGF-β1 and type I collagen were detected by real-time quantitative polymerase chain reaction(PCR).Between January 2012 and January 2018,laparoscopic excision of cyst and ductoplasty plus widened portoenterostomy were performed for 47 children with confirmed CCs with a narrow portal bile duct.The follow-up period was 15-83 months. Results Group A survived well without obstruction.Mild inflammation and fibrotic tissue were confined to bile duct periphery.In Group B,5 pigs developed stricture.Severe inflammation and diffuse fibrosis affected the whole layer of anastomosis.Fibrotic biomarkers were significantly higher postoperatively in Group B.Clinically,47 children exhibited satisfactory outcomes.The operative duration was(165±15)min and hospitalization length(9±2)days.No anastomotic stricture has been observed during a follow-up period of(31±18)months. Conclusion Laparoscopic widened-porta embedding anastomosis may be a superior option of preventing anastomotic stricture in CCs with an anastomosis <6 mm in diameter.

关 键 词：腹腔镜 胆总管囊肿 胆总管空肠吻合术 

分 类 号：R726[医药卫生—儿科] R616.5[医药卫生—临床医学]