经脐单部位法与传统四孔法腹腔镜手术治疗小儿胆总管囊肿的对比研究  

Comparative study of single-site laparoscopic and traditional four-hole laparoscopic treatment of pediatric choledochal cyst

作　　者：王博 席红卫[1] 赵正[1] 崔强强[1] 张鹏[1] 段文强[1] Wang Bo;Xi Hongwei;Zhao Zheng;Cui Qiangqiang;Zhang Peng;Duan Wenqiang(Department of General Surgery,Shanxi Provincial Children's Hospital,Taiyuan 030013,China)

机构地区：[1]山西省儿童医院普外科,山西省太原市030013

出　　处：《临床小儿外科杂志》2021年第7期658-663,共6页Journal of Clinical Pediatric Surgery

基　　金：山西省卫生计生委一般项目(编号:2015058)。

摘　　要：目的探讨经脐单部位法与传统四孔法腹腔镜手术治疗小儿胆总管囊肿的手术疗效。方法收集2016年1月至2019年6月山西省儿童医院普外科收治的30例采用经脐单部位法腹腔镜手术治疗的胆总管囊肿患者作为经脐单部位手术组;选择同期30例采用传统四孔法腹腔镜手术治疗的胆总管囊肿患者作为传统四孔法手术组,对两组临床资料、手术情况及治疗结果进行比较。结果经脐单部位手术组中,28例顺利完成手术,2例于左上腹增加一辅助孔后完成手术;传统四孔法手术组无一例中转开腹。经脐单部位手术组手术时间(238.00±50.00)min,传统四孔法手术组(201.63±65.48)min,差异有统计学意义(t=-2.418,P<0.05);术中出血量:经脐单部位手术组(11.20±10.60)mL,传统四孔法手术组(14.80±16.30)mL,差异无统计学意义(t=-1.022,P>0.05);术后进水时间:经脐单部位手术组(4.43±3.33)d,传统四孔法手术组(4.20±0.67)d,差异无统计学意义(t=-0.528,P>0.05);术后拔管时间:经脐单部位手术组(4.97±1.19)d,传统四孔法手术组(5.37±1.75)d,差异无统计学意义(t=1.035,P>0.05);术后住院天数:经脐单部位手术组(8.40±2.81)d,传统四孔法手术组(8.20±1.97)d,差异无统计学意义(t=-0.319,P>0.05);手术费用:经脐单部位手术组(2.70±0.70)万元,传统四孔法手术组(2.70±0.80)万元,差异无统计学意义(t=-0.016,P>0.05);术后并发症发生率:经脐单部位手术组6.7%,传统四孔法手术组3.3%,差异无统计学意义(χ2=0.351,P>0.05)。结论经脐单部位法腹腔镜手术治疗小儿胆总管囊肿是一种操作难度较大但安全有效的手术方式,该手术方式相对于传统四孔法可以达到腹部视觉上无明显瘢痕的效果。近期并发症与传统四孔法手术无显著差异,远期并发症需要进一步随访研究。Objective To compare clinical application value of single-site laparoscopic hepaticojejunostomy(SSLH)versus traditional four-hole laparoscopic hepaticojejunostomy(TFLH)for children with choledochal cysts(CDCs).Methods Thirty children undergoing SSLH between January 2016 to June 2019 were recruited.Another 30 children undergoing TFLH were matched for age,gender,CDC type,size and operative surgeon.The surgical outcomes of CDC children were retrospectively compared.Results SSLH was successfully completed for 28 children while another 2 cases had an addition of one extra operative hole in left upper abdomen.Meanwhile,TFLH was all successful.The average operative duration was(238.00±50.00)min in SSLH group versus(201.63±65.48)min in TFLH group.And the difference was statistically significant(t=-2.418,P<0.05).Other outcomes of average volume of intraoperative blood loss,postoperative recovery of drinking time,postoperative removal of abdominal drainage tube,postoperative hospital stay,hospitalization expenses and complication rate were similar for two groups.The differences were not statistically significant(P>0.05).Conclusion If performed by experienced laparoscopic hepaticobiliary surgeons,SSLH is safe,effective and mini-invasive.As compared with TFLH,no significant difference exists in recent complications.Long-term complications require further follow-up studies.

关 键 词：腹腔镜 单部位 胆总管囊肿/外科学 对比研究 

分 类 号：R726[医药卫生—儿科]