腹腔镜下改良胆管袢式吻合术治疗儿童胆总管囊肿的效果分析  

Analysis of the effect of laparoscopic modified biliary loop anastomosis in treatment of children with choledochal cyst

作　　者：应晓薇 樊晓鹏 陈璐 张娜 YING Xiao-wei;FAN Xiao-peng;CHEN Lu;ZHANG Na(Department of Hepatobiliary and Pancreatic Surgery,Lishui People's Hospital,Lishui,Zhejiang 323000,China;不详)

机构地区：[1]丽水市人民医院肝胆胰外科,浙江丽水323000 [2]温州市人民医院肝胆胰外科

出　　处：《中国妇幼保健》2024年第7期1344-1348,共5页Maternal and Child Health Care of China

基　　金：浙江省医学科技攻关计划项目(2019C33265)。

摘　　要：目的分析腹腔镜下改良胆管袢式吻合术治疗儿童胆总管囊肿的效果。方法选取2020年10月—2022年10月收治的60例胆总管囊肿患儿,根据不同手术方法分为对照组(25例)和改良组(35例)。对照组采用胆管空肠Roux-Y吻合术,改良组采用腹腔镜下改良胆管袢式吻合术。对比两组患儿恢复情况,术后疼痛程度,手术前后生化指标水平。对所有患儿进行随访,比较两组患儿生长发育情况和并发症发生情况。结果改良组手术时间、术中出血量、肛门排气时间、术后第1次下床活动时间、术后止痛剂使用次数及住院时间均优于对照组(均P<0.05)。两组术后疼痛程度对比差异有统计学意义(P<0.05)。手术前,两组患儿血清各项生化指标水平差异均无统计学意义(均P>0.05);手术后,改良组丙氨酸氨基转移酶(ALT)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、C-反应蛋白(CRP)及血清总胆红素(TBil)水平分别为(31.68±3.73)U/L、(48.69±5.19)U/L、(73.78±8.54)U/L、(33.26±3.57)mg/L、(15.07±3.15)μmol/L,均低于对照组的(33.61±3.64)U/L、(62.08±6.83)U/L、(84.68±9.13)U/L、(43.88±5.51)mg/L、(16.78±2.13)μmol/L,差异均有统计学意义(t=2.099、8.632、4.736、9.061、2.354,均P<0.05)。两组患儿生长发育情况和并发症发生率比较差异均有统计学意义(均P<0.05)。结论腹腔镜下改良胆管袢式吻合术治疗胆总管囊肿患儿疗效显著,可缩短手术时间,降低术中出血量,缓解术后疼痛,促进患者恢复,还可较好地维持肝功能和胆汁排泄功能,降低术后并发症发生率。Objective To analyze the effect of laparoscopic modified biliary loop anastomosis in treatment of children with choledochal cyst.Methods Sixty children with choledochal cyst treated in Lishui People's Hospital from October 2020 to October 2022 were selected and divided into two groups according to different surgical methods:control group(25 cases)and modified group(35 cases).The children in control group underwent Roux-Y cholangiojejunostomy,and the children in modified group underwent laparoscopic modified loop cholangiojejunostomy.The recovery status,postoperative pain degrees,and levels of biochemical indicators before and after surgery in the two groups were compared.All the children were followed up to compare their growth and development status and occurrence of complications between the two groups.Results The operation time,the amount of intraoperative blood loss,anal exhaust time,the first time out of bed after operation,the usage times of postoperative analgesics,and the length of hospital stay in modified group were less than those in control group(P<0.05).There were significant differences in postoperative pain degrees at different time points between the two groups(P<0.05).Before surgery,there was no statistically significant difference in serum biochemical indicators between the two groups(P>0.05).After surgery,the levels of alanine aminotransferase(ALT),glutamyltranspeptidase(GGT),alkaline phosphatase(ALP),C-reactive protein(CRP),and serum total bilirubin in modified group were(31.68±3.73)U/L,(48.69±5.19)U/L,(73.78±8.54)U/L,(33.26±3.57)mg/L,and(15.07±3.15)μmol/L,respectively,which were lower than those in control group[(33.61±3.64)U/L,(62.08±6.83)U/L,(84.68±9.13)U/L,(43.88±5.51)mg/L,(16.78±2.13)μmol/L],there were statistically significant differences(t=2.099,8.632,4.736,9.061,2.354,all P<0.05).There were statistically significant differences in growth and development status and incidence rate of complications between the two groups(P<0.05).Conclusion Laparoscopic modified biliary loop an

关 键 词：腹腔镜下改良胆管袢式吻合术 儿童 胆总管囊肿 疗效 

分 类 号：R726.1[医药卫生—儿科]