新生儿及小婴儿先天性胆管扩张症临床特征分析及微创治疗  

Clinical characteristics and minimally invasive treatment in newborns and young infants with congenital cystic dilatation

作　　者：路长贵[1] 唐维兵[1] Changgui Lu;Weibing Tang(Department of Neonatal Surgery,Children′s Hospital Of Nanjing Medical University,Jiangsu 210008,China)

机构地区：[1]南京医科大学附属儿童医院新生儿外科,江苏210008

出　　处：《中华腔镜外科杂志（电子版）》2024年第2期76-82,共7页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨新生儿及小婴儿胆管扩张症(congenital biliary dilatation,CBD)临床特征及腹腔镜治疗的安全性、有效性。方法90例CBD患儿首先按手术年龄分为<1月龄组(20例),1~2月龄组(29例),2~3月龄组(18例)和>3月龄组(23例),收集术前临床信息,比较各年龄组临床特征。将90例患儿分为腹腔镜组(n=47)和开腹组(n=43),比较两组术后恢复指标和并发症发生情况,探讨腹腔镜技术应用于新生儿及小婴儿CBD的安全性和有效性。结果74.4%(67/90例)的CBD产前被发现,术前谷氨酸丙酮酸转移酶(alanine aminotransgerase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)及天门冬氨酸氨基转移酶血小板比值(aspartate aminotransferase platelet ratios,APRI)在各年龄组之间差异有统计学意义(z=66.338,P<0.001;z=50.214,P<0.001;z=33.680,P<0.001;z=13.708,P=0.003),两两比较后发现<1月龄组和1~2月龄组术前ALT和AST均明显低于2~3月龄和>3月龄组(Bonferroni矫正P值均<0.05);1~2月龄组术前APRI值明显低于2~3月龄及>3月龄组(Bonferroni矫正P值均<0.05);腹腔镜组术后初次经口喂养时间、完全经口喂养时间和术后住院时间均明显短于开腹组(z=-3.743,P<0.001;z=-2.186,P=0.029;z=-2.186,P=0.029),腹腔镜组和开腹组之间术后肝功能改善率、吻合口瘘及狭窄发生率差异均无统计学意义(P>0.05)。结论新生儿及小婴儿CBD多在产前发现,患儿肝功能和肝纤维化指标ALT、AST和APRI可能在2月龄后明显恶化;对新生儿及小婴儿CBD实施腹腔镜手术安全有效,可使初次经口喂养和完全经口喂养时间提前,缩短术后住院时间,不增加并发症发生率。Objective To explore the clinical characteristics,safety and efficacy of laparoscopic surgery for newborns and young infants with congenital cystic dilatation.Methods Ninety patients were enrolled in this study and divided into 4 subgroups according to age at surgery(20 patients in the<1 month group,29 in the 1-2 months group,18 in the 2-3 months group and 23 in the>3 months group).Preoperative information was collected and compared among subage groups to explore the clinical characteristics.Additionally,90 patients were divided into a laparoscopic group(n=47)and an open group(n=43)to compare the postoperative recovery indices and the occurrence of complications to determine the safety and efficacy of laparoscopic application to CBD in neonates and young infants.Results A total of 74.4%(67/90)of CBDs were diagnosed prenatally.There were significant differences in preoperative ALT levels,preoperative AST levels and preoperative aspartate aminotransferase platelet ratios index(APRI)among the subage groups(z=66.338,P<0.001;z=50.214,P<0.001;z=33.680,P<0.001;z=13.708,P=0.003);however,these values of ALT and AST were significantly lower in the<1 month and 1-2 months groups than in the 2-3 months or>3 months group(Bonferroni corrected P values<0.05).The value of APRI in the 1-2 months group was lower than that in the 2-3 months or>3 months group(Bonferroni corrected P values<0.05).The initial oral feeding time,complete oral feeding time and postoperative hospitalization duration in the laparoscopic group were significantly shorter than those in the open group(z=-3.743,P<0.001;z=-2.186,P=0.029;z=-2.186,P=0.029).There were no significant differences in the rates of postoperative liver function improvement,anastomotic leakage or stenosis between the laparoscopic and open surgery groups(all P>0.05).Conclusion CBD in newborns and young infants may usually be detected prenatally,and liver function and liver fibrosis may deteriorate after 2 months of age.In addition,laparoscopic surgery for CBD in newborns and young infants is

关 键 词：新生儿 小婴儿 胆管扩张症 临床特征 微创 

分 类 号：R722.1[医药卫生—儿科]