完全腹腔镜胆总管囊肿切除术和不同胆道重建术临床效果研究  

Clinical efficacy of complete laparoscopic choledochal cyst resection followed by different biliary tract reconstructions

作　　者：杜加录 张凯 路志宇 高建华 Du Jialu;Zhang Kai;Lu Zhiyu(Department of General Surgery,First Hospital,Affiliated to Yan'an University,Yulin 719000,Shaanxi Province,China)

机构地区：[1]延安大学第二附属医院/陕西省榆林市第一医院普通外科,陕西省榆林市719000 [2]延安大学第二附属医院/陕西省榆林市第一医院普通外科二病区

出　　处：《实用肝脏病杂志》2022年第5期742-745,共4页Journal of Practical Hepatology

基　　金：陕西省科技厅重点研发计划项目(编号:2020SF-216)。

摘　　要：目的分析比较完全腹腔镜胆总管囊肿切除术联合不同胆道重建术治疗先天性胆总管囊肿(CCC)患者的临床效果。方法2016年1月~2020年5月我院诊治的81例CCC患儿,接受腹腔镜胆总管囊肿切除术,在胆管重建时,其中28例(A组)接受肝管十二指肠吻合术(HA),30例(B组)接受肝管空肠Roux-en-Y吻合术(RH),23例(C组)接受改良胆管袢式吻合术(MCL)。结果在术后3个月,C组临床显效率为69.6%,显著高于A组的35.7%或B组的43.3%(P<0.05);在术后3 d,C组血清CRP水平为(12.9±2.4)mg/L,显著低于A组【(14.6±2.9)mg/L,P<0.05】或B组【(16.7±2.8)mg/L,P<0.05】;术后,三组胆漏、胰漏、胆道出血、急性胆管炎和腹腔积液等并发症发生率分别为21.4%、16.7%和8.7%,无显著性差异(P>0.05)。结论采用MCL吻合术治疗CCC患者总体临床疗效优于HA吻合术或RH吻合术,在手术过程中不游离空肠,可完全于腹腔镜下实施操作,创面小,能显著缩短手术时长,有利于肠蠕动恢复,减轻炎症反应,进而改善患儿预后。Objective The aim of this study was to investigate the clinical efficacy of complete laparoscopic choledochal cyst resection followed by different biliary tract reconstructions.Methods 81 children with congenital choledochal cyst(CCC)were encountered in our hospital between January 2016 and May 2020,and all underwent complete laparoscopic choledochal cyst resection.As for biliary tract reconstruction,the hepaticoduodenostomy(HA)was done in 28 cases(group A),the hepatojejunal Roux-en-Y anastomosis(HR)was adopted in 30 cases(group B),and the modified cholangio-intestinal loop anastomosis(MCL)was performed in 23 cases(group C).Results At the end of 3 month followed-up after surgery,the clinically markedly effective rate in group C was 69.6%,significantly higher than 35.7%in group A or 43.3%in group B(P<0.05);at day three after operation,serum C-reactive protein level in group C was(12.9±2.4)mg/L,significantly lower than(14.6±2.9)mg/L in group A(P<0.05)or(16.7±2.8)mg/L in group B(P<0.05);the incidences of post-operational complications,such as bile leak,pancreatic leak,biliary bleeding,acute cholangitis and ascites in the three groups were 21.4%,16.7%and 8.7%,not significantly different among them(P>0.05).Conclusion The application of modified cholangio-intestinal loop anastomosis in the treatment of children with CCC has a better overall clinical efficacy among others,which might be related to relatively easy complete operation under laparoscopy without dissociation of jejunum and little inflammatory reactions.

关 键 词：先天性胆总管囊肿 腹腔镜 肝十二指肠吻合术 肝管空肠Roux-en-Y吻合术 改良胆肠袢式吻合术 治疗 

分 类 号：R657.4[医药卫生—外科学]