腹腔镜下手术在儿童先天性胆总管扩张中的应用分析  

Application analysis of laparoscopic surgery in children with congenital choledochus dilatation

作　　者：金明均[1] 董亮[1] 杨宏[1] 董迎[1] 包国强[1] 崔华雷[1] JIN Ming-jun;DONG Liang;YANG Hong;DONG Ying;BAO Guo-qiang;CUI Hua-lei(Department of Surgery, Tianjin Children′s Hospital, Tianjin 300070, China)

机构地区：[1]天津市儿童医院外科,天津300070

出　　处：《河北医科大学学报》2021年第9期1073-1077,共5页Journal of Hebei Medical University

基　　金：天津市科技计划项目(14RCGFSY00150)。

摘　　要：目的探讨腹腔镜下手术在儿童先天性胆总管扩张(congenital choledochus dilatation,CCD)中的应用效果及安全性。方法选择50例行腹腔镜手术治疗的CCD患儿作为观察组,同时选取同期行开腹手术治疗的50例CCD患儿作为对照组,两组均行扩张胆管囊肿切除+肝总管空肠Roux-Y吻合术治疗。比较两组手术相关情况,手术前后检测两组肝功能指标以及炎症指标。结果观察组手术时间长于对照组,术中出血量低于对照组,术后排便时间、术后进食时间、术后住院时间短于对照组,差异均有统计学意义(P<0.05)。从术前1 d到术后7 d的血清总胆红素(total bilirubin,TBIL)、丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate transaminase,AST)、C反应蛋白(C-reactive protein,CRP)和白细胞介素6(interleukin-6,IL-6)水平,观察组和对照组差异有统计学意义。观察组并发症发生率低于对照组,差异有统计学意义(χ2=5.316,P<0.05)。两组平均手术及住院费用比较,差异无统计学意义(t=1.518,P>0.05)。结论腹腔镜下扩张胆总管囊肿切除+肝总管空肠Roux-Y吻合术治疗儿童CCD相对于开腹手术能有效减轻手术创伤性应激与炎症反应,术后恢复快,并发症少。Objective To explore the effect and safety of laparoscopic surgery on children with congenital choledochus dilatation(CCD).Methods A total of 50 children with CCD who underwent laparoscopic surgery were selected as the research subjects(the observation group),and 50 children with CCD who underwent laparotomy during the same period were selected as the control group.Both groups underwent the resection of bile duct cysts and Roux-Y anastomosis of common hepatic duct-jejunum.The operation-reelated conditions of two groups were compared,and the liver function indexes and inflammation indexes of the two groups were detected before and after operation.Results The duration of operation was longer in the observation group than in the control group,the intraoperative bleeding volume was lower than that of the control group,and the postoperative defecation time,postoperative time of food intake and postoperative hospital stay were shorter than those of the control group(P<0.05).There were significant differences in the level of total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate transaminase(AST),C-reactive protein(CRP)and interleukin 6(IL-6)in the observation group and the control group from 1 d before operation to 7 d after operation,and the incidence of complications was lower in the observation group than in the control group,suggesting significant difference(χ2=5.316,P<0.05).There was no significant difference in the average operation and hospitalization expenses between two groups(t=1.518,P>0.05).Conclusion Compared with the laparotomy,the laparoscopic resection of bile duct cysts combined with Roux-Y anastomosis of common hepatic duct-jejunum can effectively reduce the traumatic stress and inflammatory response,with faster postoperative recovery and fewer complications.

关 键 词：胆总管囊肿 腹腔镜 胆总管造口术 

分 类 号：R735.8[医药卫生—肿瘤]