腹腔镜肝门肠吻合术治疗新生儿胆道闭锁症疗效初步研究  

Preliminary study of laparoscopic hepatic portoenteral anastomosis in the treatment of neonatal with biliary atresia

作　　者：张燕妮[1] 孙晓花 何海燕[1] 杜芸芸 韩慧 Zhang Yanni;Sun Xiaohua;He Haiyan(Department of Neonatal Surgery,Maternity and Childcare Hospital,Ankang 725000,Shaanxi Province,China)

机构地区：[1]陕西省安康市妇幼保健院新生儿科,725000 [2]西安交通大学附属儿童医院儿内科

出　　处：《实用肝脏病杂志》2019年第6期920-923,共4页Journal of Practical Hepatology

基　　金：陕西省科技攻关项目(编号:2013SF2-10)

摘　　要：目的探讨采用腹腔镜肝门肠吻合术治疗新生儿胆道闭锁症(BA)的疗效及其血清IL-12p40和IL-13Rα2水平变化。方法2014年3月~2018年6月在我院接受救治的72例BA患儿,其中42例接受腹腔镜肝门肠吻合术,30例接受开腹肝门肠吻合术治疗。采用ELISA法检测血清IL-12p40和IL-13Rα2水平。结果术前,腔镜组患儿年龄为(55.8±7.4)d,身高为(64.4±2.8)cm,体质量为(3.8±0.6)kg,与开腹组的(57.3±8.2)d,身高为(65.2±3.0)cm,体质量为(4.1±0.8)kg比,差异无显著性(P>0.05);腹腔镜组患儿手术时间长于开腹组【(187.8±32.6)min对(152.4±39.3)min,P<0.05】,但术中出血量和进食时间均显著少于或快于开腹组【分别为(15.3±5.2)mL对(33.6±12.6)mL,P<0.05和(1.3±0.4)d对(2.3±0.7)d,P<0.05】,两组患儿术后麻醉苏醒时间比较,差异无统计学意义【(77.5±18.0)min对(82.1±20.2)min,P>0.05】;手术前,开腹组血清IL-12p40和IL-13Rα2水平分别为【0.7(0.1,2.0)】ng/mL和【6.3(2.2,17.6)】ng/mL,与腔镜组的【0.8(0.2,2.4)】ng/mL和【6.7(2.0,19.3)】ng/mL比,无显著差异(P>0.05),术后分别为【0.4(0.1,0.9)】ng/mL和【1.1(0.4,3.6)】ng/mL,与腔镜组的【0.4(0.2,1.0)】ng/mL和【1.1(0.6,4.0)】ng/mL比,也无显著差异(P>0.05);术后随访3个月,37例(51.4%)BA患儿预后良好,其中腹腔镜组5例(11.9%)继发胆管炎死亡,开腹组4例(13.3%)死亡,两组患儿预后情况比较,差异无统计学意义(P>0.05)。结论采用腹腔镜肝门肠吻合术治疗新生儿胆道闭锁症疗效确切、安全,值得进一步验证。Objective The aim of this preliminary study was to explore the efficacy of laparoscopic hepatic portoenteral anastomosis(HPEA)in the treatment of neonatal with biliary atresia(BA)and the changes of serum interleukin(IL)-12p40 and IL-13Rα2 levels.Methods 72 infants with BA were recruited in our hospital between March 2014 and June 2018,and laparoscopic HPEA was performed in 42,and open HPEA was undergone in 30 infants.Serum IL-12p40 and IL-13Rα2 levels were detected by ELISA.Results At presentation,the ages,heights and body weights in the two groups were not significantly different(P>0.05);the operation time in the laparoscopic HPEA was longer than that in the open operation[(187.8±32.6)min vs.(152.4±39.3)min,P<0.05],while the intraoperative blood loss and feeding time were much less or shorter than in the open surgery[(15.3±5.2)mL vs.(33.6±12.6)mL,P<0.05 and(1.3±0.4)d vs.(2.3±0.7)d,respectively,P<0.05],and there was no significant difference as respect to the postoperative anesthesia recovery time between the two groups[(77.5±18.0)min vs.(82.1±20.2)min,P>0.05];before operation,serum IL-12p40 and IL-13Rα2 levels in the open operation were[0.7(0.1,2.0)]ng/mL and[6.3(2.2,17.6)]ng/mL,not significantly different as compared to[0.8(0.2,2.4)]ng/mL and[6.7(2.0,19.3)]ng/mL in laparoscopic operation,and after operation,they were[0.4(0.1,0.9)]ng/mL and[1.1(0.4,3.6)]ng/mL,also not significantly different compared to[0.4(0.2,1.0)]ng/mL and[1.1(0.6,4.0)]ng/mL,respectively,in the laparoscopic HPEA(P>0.05);at three-month follow-up,37(51.4%)infants with BA survived,and 5(11.9%)laparoscopic HPEA-treated and 4 open HPEA-treated infants died(P>0.05).Conclusion Laparoscopic HPEA is an alternative modality for the management of neonatal with biliary atresia.

关 键 词：胆道闭锁症 腹腔镜 肝门肠吻合术 白细胞介素-12p40 IL-13RΑ2 

分 类 号：R65[医药卫生—外科学]