改良三孔法腹腔镜治疗3月内婴幼儿胆总管囊肿的经验体会  

Clinical experience on modified 3-port laparoscopic excision of choledochal cyst in infants under 3 months

作　　者：范美丽[1,2] 杨书龙 李昭铸[1] 杜航[1] FAN Mei-li;YANG Shu-long;LI Zhao-zhu;DU Hang(Department of Pediatric Surgery,The Second Affiliated Hospital of Harbin Medical University,Harbin 150081,China;Department of General Surgery,The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第二医院儿外科,黑龙江哈尔滨150081 [2]哈尔滨医科大学附属第一医院普外科,黑龙江哈尔滨150001

出　　处：《哈尔滨医科大学学报》2021年第1期68-71,共4页Journal of Harbin Medical University

摘　　要：目的探讨改良三孔法腹腔镜治疗3月内婴幼儿胆总管囊肿的经验体会。方法回顾性分析2014年9月~2018年12月单中心收治的39例实施腹腔镜胆总管囊肿根治手术患儿的病例资料,分为3月内婴幼儿组和大于3月龄组。3月内婴幼儿组采用改良三孔法腹腔镜(脐部放置两个trocar,右上腹放置一个trocar胆总管囊肿根治手术;大于3月龄组采用传统腹腔镜胆总管囊肿根治手术。胆总管囊肿游离和胆肠吻合在腔镜下完成,肠间吻合经脐部切口拖出体外完成。结果7例3月内婴幼儿手术全部在腹腔镜下完成,无中转开放手术;32例大于3月龄患儿中转开放1例,两组中转开放率比较无显著差异(P>0.05)。3月内婴幼儿组腔镜下手术时间为(164.29±14.56)min,术中出血量为(7.86±2.67)mL;大于3月龄组的手术时间为(174.84±11.74)min,术中出血量为(16.56±11.03)mL,两组比较差异具有统计学意义(P<0.05);与大于3月龄组比较,3月内婴幼儿组术后进食时间及住院时间差异无统计学意义。术后随访6~63个月,3月内婴幼儿组与大于3月龄组比较,并发症发生率差异无统计学意义。结论改良三孔法腹腔镜胆总管囊肿根治术适用于3月龄以下婴幼儿,手术效果满意。Objective To discuss the experience of modified 3-port laparoscopic excision of choledochal cyst in infants under 3 months.Methods Retrospective analysis was performed for clinical data of 39 children who underwent laparoscopic excision of choledochal cyst in our hospital from September 2014 to December 2018.The cases were reviewed and analyzed in 2 groups(infant group under 3 months and older group).In infant group under 3 months,2 trocars were placed in the umbilicus,and another trocar was located in the right upper quadrant)laparoscopic excision of choledochal cyst.In older group,separating choledochocyst and cholangioenterostomy were completed under laparoscopy,and entero-enterostomy was performed by umbilic incision.Results A total of 7 patients under 3 months of choledochal cyst were all treated with laparoscopic excision of choledochal cyst.No one was changed to open operation.One of the 32 patients in older group was converted into open surgery.There was no significant differences in the rate of open operation between the two groups.As compared with older group,infant group under 3 months offered shorter laparoscopic operative duration(164.29 min±14.56 min vs 174.84 min±11.74 min,P<0.05)and less volume of blood loss(7.86 mL±2.67 mL vs 16.56 mL±11.03 mL,P<0.05).No significant differences existed between the two groups in eating time(3.57 d±0.79 d vs 4.16 d±1.11 d,P>0.05)and hospitalization stay(7.57 d±1.13 d vs 8.22 d±1.66 d,P>0.05)after surgery.Postoperative follow-up was conducted for 6~63 months.Compared with older group,the incidence of complications was no statistically significant difference in infant group under 3 months(P>0.05).Conclusion Modified 3-port laparoscopic surgical excision of infantile(under 3 months)choledochal cyst is a feasible surgical alternative and the efficacy of laparoscopic surgical excision is satisfactory.

关 键 词：腹腔镜 手术 3月龄 胆总管囊肿 

分 类 号：R657.4[医药卫生—外科学]