不同年龄胆道闭锁患儿行腹腔镜下肝门暴露术的效果及预后比较  

Comparison of Effect and Prognosis of Laparoscopic Hepatic Hilum Exposure in Infants with Biliary Atresia of Different Ages

作　　者：蔡久英[1] 王忍[1] 李炳[1] 夏顺林[1] 黄霞[1] 孟红艳[1] CAI Jiuying;WANG Ren;LI Bing;XIA Shunlin;HUANG Xia;MENG Hongyan(Department of Pediatric Surgery,Huai′an Maternity and Child Health Hospital,Huai′an 223002,China)

机构地区：[1]淮安市妇幼保健院小儿外科,江苏淮安223002

出　　处：《医学综述》2021年第24期4988-4992,共5页Medical Recapitulate

摘　　要：目的探讨腹腔镜下肝门暴露技术在不同年龄婴儿胆道闭锁中的应用及其对患儿预后的影响。方法选择2012年1月至2020年3月淮安市妇幼保健院收治的胆道闭锁患儿66例,按年龄不同分为30~60 d组(20例)、>60~90 d组(28例)、>90~120 d组(18例)。患儿均采用腹腔镜下肝门肠吻合术治疗,术中充分暴露肝门。比较三组患儿手术相关情况,肝纤维化程度及胆管反应程度,术后随访6个月,比较总胆红素水平和黄疸消退率。结果三组手术成功率、手术时间、术中出血量及并发症发生率比较差异无统计学意义(P>0.05)。>60~90 d组和>90~120 d组肝纤维化程度重于30~60 d组(P<0.05),>90~120 d组重于>60~90 d组(P<0.05);>60~90 d组和>90~120 d组胆管面积占比大于30~60 d组[(6.5±1.3)%、(8.4±1.5)%比(5.1±1.1)%](P<0.05),>90~120 d组大于>60~90 d组(P<0.05)。总胆红素不同时点间的主效应差异有统计学意义(P<0.01),术前、术后2周及术后6个月三组总胆红素水平呈下降趋势。术后2周,>60~90 d组和>90~120 d组黄疸消退率低于30~60 d组[46.4%(13/28)、16.7%(3/18)比75.0%(15/20)](P<0.05),>90~120 d组低于>60~90 d组(P<0.05),术后6个月三组患儿黄疸消退率比较差异无统计学意义(P>0.05)。结论针对胆道闭锁患儿应用腹腔镜下肝门暴露技术可协助完成腹腔镜下肝门吻合术,降低中转手术率,手术效果较好。术后2周内患儿年龄越大,黄疸消退率越低,尽早治疗对预后有积极作用。Objective To explore the application of laparoscopic hepatic hilum exposure technique in biliary atresia in infants of different ages,and its influence on the prognosis.Methods A total of 66 infants with biliary atresia admitted to the Huai′an Maternal and Child Health Hospital from Jan.2012 to Mar.2020 were included and divided into a 30-60 d group(20 cases),a>60-90 d group(28 cases)and a>90-120 d group(18 cases)according to the age of the infants.All of the infants were treated with laparoscopic hilar enterostomy,and the hepatic hilum was fully exposed during the operation.The operation related situation,degree of liver fibrosis and degree of bile duct reaction were compared among the three groups.The postoperative follow-up was 6 months,and the total bilirubin level and jaundice regression rate were compared.Results There was no statistically significant difference in the operation success rate,operation time,intraoperative blood loss and complication rate among the three groups(P>0.05).The degree of liver fibrosis in the>60-90 d and the>90-120 d group was higher than that in the 30-60 d group(P<0.05),and the degree of liver fibrosis in the>90-120 d group was higher than that in the>60-90 d group(P<0.05).The proportion of bile duct area in the>60-90 d group and the>90-120 d group was higher than that in the 30-60 d group[(6.5±1.3)%,(8.4±1.5)%vs(5.1±1.1)%](P<0.05),and that in the>90-120 d group was higher than that in the>60-90 d group(P<0.05).The main effect of total bilirubin at different time points was significantly different(P<0.01),and the levels of total bilirubin in the three groups showed a downward trend from before surgery,2 weeks after surgery and 6 months after surgery.Two weeks after operation,the rates of jaundice regression in the>60-90 d group and the>90-120 d group were lower than that in the 30-60 d group[46.4%(13/28),16.7%(3/18)vs 75.0%(15/20)](P<0.05),and that in the>90-120 d group was lower than that in the>60-90 d group(P<0.05).There was no statistically significant difference in the

关 键 词：胆道闭锁 患儿 肝门暴露 预后 

分 类 号：R575.7[医药卫生—消化系统]