胆道闭锁患儿Kasai术中不同肝门暴露技术围手术期对比  

To compare the different hepatic portal exposure techniques in Kasai surgery during their different perioperative periods

作　　者：许可 方一凡 刘明坤[1] 林宇[1] 何渊彬 陈晓艺[1] 吴典明[1] Xu Ke;Fang Yifan;Liu Mingkun;Lin Yu;He Yuanbin;Chen Xiaoyi;Wu Dianming(Department of General Surgery,Fujian Children’s Hospital(Fujian Branch of Shanghai Children’s Medical Center),College of Clinical Medicine for Obstetrics&Gynecology and Pediatrics,Fujian Medical University,Fuzhou 350011,China)

机构地区：[1]福建省儿童医院(上海儿童医学中心福建医院)福建医科大学妇儿临床医学院普外科,福州350011

出　　处：《中华肝胆外科杂志》2023年第3期181-184,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的:比较不同肝门区暴露技术对胆道闭锁患儿Kasai手术围手术期影响。方法:回顾性分析2017年1月至2020年10月福建省儿童医院行Kasai手术的Ⅲ型胆道闭锁患儿资料。共入组45例患儿,其中男24例,女21例,年龄(71.3±21.0)d。45例患儿中Kasai手术中彻底游离肝门区门静脉左右分支、肝左右动脉分支并弹性牵拉以暴露肝门纳入游离组(n=22),无此操作纳入对照组(n=23)。对比两组术后住院时间、术后直接胆红素、术后并发症和术后自体肝生存情况。结果:游离组术后住院时间(17.1±4.4)d,低于对照组(20.1±5.4)d,差异均有统计学意义(t=2.07,P=0.044)。对照组术后3个月直接胆红素30.0(10.7,108.0)μmol/L,高于游离组14.5(4.0,37.5)μmol/L,差异有统计学意义(Z=-2.16,P=0.031)。对照组21例(91.3%)术后频发胆管炎,游离组13例(59.1%)术后频发胆管炎。对照组频发胆管炎高于游离组,差异有统计学意义(χ^(2)=4.69,P=0.030)。术后1年对照组11例(47.8%)未行肝移植,均存活;游离组15例(68.2%)未行肝移植,均存活。术后2年对照组7例(30.4%)未行肝移植,均存活;游离组10例(45.5%)未行肝移植,均存活。结论:对于Ⅲ型胆道闭锁患儿,Kasai术中彻底游离肝门区门静脉左右分支、肝左右动脉分支并弹性牵拉这一暴露肝门操作增加了手术安全性,减少住院时间。Objective To compare the impact of different portal exposure techniques in the Kasai surgery on children with typeⅢ.biliary atresia during their different perioperative periods.Methods A retrospective study was performed on the data of children with typeⅢ.biliary atresia who underwent Kasai surgery at Fujian Children's Hospital from January 2017 to October 2020.Of 45 children enrolled in this study,there were 24 males and 21 females,aged(71.3±21.0)days.Patients who had left and right branches of the portal vein and the left and right hepatic arteries in the portal area being completely freed and elastically stretched during the Kasai operation were included into the free group(n=22)and the remaining patients were included in the control group(n=23).Postoperative hospital stay,postoperative direct bilirubin levels,postoperative complications and transplant-free survival after the Kasai operation were compared between the 2 groups.Results Postoperative hospital stay of(17.1±4.4)d in the free group was significantly lower than that in the control group(20.1±5.4)d,(t=2.07,P=0.044).The direct bilirubin level at 3 months after surgery for the control group was 30.0(109,108.0)μmol/L,which was significantly higher than that of 14.5(4.0,37.5)μmol/L in the free group(Z=-2.16,P=0.031).Twenty-one patients(91.3%)in the control group had frequent attacks of postoperative cholangitis,compared with 13 patients(59.1%)in the free group.The difference was statistically significant(χ^(2)=4.69,P=0.030).Eleven surviving patients(47.8%)in the control group did not undergo liver transplantation at one year after surgery,compared with 15 patients(68.2%)in the free group.At two years after surgery,7 surviving patients(30.4%)in the control group did not undergo liver transplantation compared with 10 patients(45.5%)in the free group.Conclusion For children with typeⅢ.biliary atresia,completely freeing the left and right branches of portal vein,and left and right hepatic arteries in the liver portal area,and elastically stretchin

关 键 词：胆道闭锁 胆管肠吻合术 肝 围手术期 暴露肝门 

分 类 号：R726.5[医药卫生—儿科]