完全腹腔镜与开放Kasai手术治疗Ⅲ型胆道闭锁的对比研究  

A comparative study of total laparoscopic versus open Kasai portoenterostomy for type Ⅲ biliary atresia

作　　者：冯勇 周崇高 夏仁鹏 邹婵娟 许光 董洁 李波[1] Feng Yong;Zhou Chonggao;Xia Renpeng;Zou Chanjuan;Xu Guang;Dong Jie;Li Bo(Fetal and Neonatal Surgery,Affiliated Children’s Hospital,Xiangya School of Medicine,Central South University(Hunan Children’s Hospital),Changsha 410007,China;Institute of Pediatric Medicine,Affiliated Children’s Hospital,Xiangya School of Medicine,Central South University(Hunan Children’s Hospital),Changsha 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院湖南省儿童医院胎儿与新生儿外科,长沙410007 [2]中南大学湘雅医学院附属儿童医院湖南省儿童医院儿科医学研究所,长沙410007

出　　处：《临床小儿外科杂志》2025年第3期231-235,共5页Journal of Clinical Pediatric Surgery

基　　金：国家临床重点专科重大科研专项(Z20230059);湖南省出生缺陷协同防治科技重大专项(2019SK1010);湖南省自然科学基金(2025JJ50672)。

摘　　要：目的对比分析完全腹腔镜与开放Kasai手术治疗婴儿Ⅲ型胆道闭锁的临床疗效。方法回顾性分析2020年5月至2021年12月湖南省儿童医院14例完全腹腔镜Kasai手术(为完全腹腔镜组)与66例开放Kasai术胆道闭锁患儿(为开放组)的临床资料,对比分析两组患儿性别、手术日龄、体重、术前总胆红素、直接胆红素、谷丙转氨酶、谷氨酰转移酶(gamma-glutamyl transferase,GGT)、天门冬氨酸氨基转移酶与血小板比值(aspartate aminotransferase-to-platelet ratio index,APRI),手术时间、术中出血量、恢复进食时间、术后住院天数、术后并发症(胆瘘、肠瘘、肠梗阻、伤口裂开)及术后胆管炎发生率、早期胆管炎发生率、频发胆管炎发生率、黄疸清除率、1年及2年自体肝生存率(survival rate of native liver,SNL)、生存率等临床资料。结果完全腹腔镜组与开放组相比,手术时间更长,差异有统计学意义(P<0.05);而出血量、恢复进食时间、术后住院时间、胆管炎发生率(71.4%比48.5%)、早期胆管炎发生率(28.6%比19.7%)、频发胆管炎发生率(14.3%比15.2%)、黄疸清除率(71.4%比69.7%)、1年SNL(57.1%比75.8%)、2年SNL(57.1%比71.2%)、1年生存率(78.6%比84.8%)及2年生存率(78.6%比81.8%)差异,均无统计学意义(P>0.05)。结论完全腹腔镜Kasai手术治疗婴儿胆道闭锁安全、可行,与开放Kasai手术相比更加微创,而疗效无明显差异。Objective To compare the efficacy of total laparoscopic versus open Kasai portoenterostomy for typeⅢbiliary atresia(BA).Methods From May 2020 to December 2021,the relevant clinical data were retrospectively reviewed for 14 children undergoing laparoscopic Kasai portoenterostomy and 66 cases undergoing open Kasai portoenterostomy.Two groups were compared with regards to gender,operative age,body weight,preoperative total bilirubin,direct bilirubin,alanine aminotransferase,gamma-glutamyl transferase,aspartate aminotransferase-to-platelet ratio index,operative duration,volume of blood loss,time of feeding recovery,postoperative hospitalization stay,postoperative complications(biliary fistula,intestinal fistula,intestinal obstruction&wound dehiscence),postoperative cholangitis rate,early cholangitis rate,frequent cholangitis rate,jaundice clearance rate,1/2-year survival rate of native liver(SNL)and survival rate.Results There was statistically significant inter-group difference(P<0.05)in operative duration.No statistically significant difference(P>0.05)existed in volume of blood loss,time of feeding recovery,postoperative hospitalization stay,postoperative cholangitis rate(71.4%vs.48.5%),early cholangitis rate(28.6%vs.19.7%),frequent cholangitis rate(14.3%vs.15.2%),jaundice clearance rate(71.4%vs.69.7%),1-year SNL(57.1%vs.75.8%),2-year SNL(57.1%vs.71.2%),1-year survival rate(78.6%vs.84.8%)and 2-year survival rate(78.6%vs.81.8%).Conclusions Total laparoscopic Kasai portoenterostomy is safe,feasible and mini-invasive.Its outcomes are superior to those of open surgery.

关 键 词：腹腔镜 胆道闭锁 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]