改良脐部切口单孔腹腔镜胆总管囊肿根治术的安全性与有效性初探:一项回顾性队列研究

Preliminary study of the safety and efficacy of modified single-incision laparoscopy for choledochal cysts:a retrospective cohort study

目的初步探讨改良脐部切口单孔腹腔镜胆总管囊肿切除、肝总管空肠Roux-en-Y吻合术(single-port laparoscopic choledochal cyst excision and Roux-en-y hepaticojejunostomy,SPCH)治疗胆总管囊肿的安全性及有效性。方法本研究为回顾性队列研究,纳入2018年1月1日至2022年12月31日广州市妇女儿童医疗中心收治并最终行手术治疗的62例胆总管囊肿患儿作为研究对象,患儿均经磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)确诊并接受SPCH(为SPCN组,n=43)和多孔腹腔镜胆总管囊肿切除、肝总管空肠Roux-en-Y吻合术(multiple-port laparoscopic choledochal cyst excision and Roux-En-Y hepaticojejunostomy,MPCH,为MPCH组,n=19)治疗,通过病历系统采集相关数据(住院时间、手术时间、术后并发症等),对患儿基线临床特征、短期疗效进行比较。结果MPCH组和SPCH组患儿基线数据(性别、手术月龄、Todani分型、临床表现、产前诊断情况及囊肿最长径)差异无统计学意义(P>0.05),具备可比性。SPCH组平均术后住院时间较MPCH组短,差异无统计学意义[(7.14±2.70)d比(7.58±3.27)d,P=0.892];手术时间[(266.79±69.39)min比(277.32±90.23)min,P=0.913]和出血量[(8.88±12.37)mL比(16.68±34.84)mL,P=0.758]差异亦无统计学意义。MPCH组放置引流管的数量明显多于SPCH组(11/19比7/43,P<0.001)。两组除SPCH组有1例出现肝肠吻合部狭窄以外,其余患儿随访期间未见手术相关并发症,SPCH组与MPCH组并发症发生率(2.33%比0.00%)差异无统计学意义(P=0.500)。结论改良SPCH手术的安全性及有效性与MPCH相当,但前者有助于降低单孔腹腔镜手术的操作难度。

Objective To explore the safety and efficacy of single-port laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy(SPCH).Methods Between January 1,2018,and December 31,2022,62 consecutive cases of choledochal cysts were recruited.The procedure was either SPCH(n=43)or multiple-port laparoscopic choledochal cysts excision and Roux-en-Y hepaticojejunostomy(MPCH)(n=19).Magnetic resonance cholangiopancreatography(MRCP)was performed.Baseline clinical characteristics,short-term efficacy and safety outcomes were examined through reviewing the relevant medical records.Results No significant inter-group differences existed in such baseline clinical characteristics as gender,operative age,Todani classification,clinical presentation,prenatal diagnosis&longest diameter of cyst.Average postoperative hospitalization stay of SPCH group was shorter than that of MPCH group(7.14±2.70 vs.7.58±3.27 day,P=0.892).However,the inter-group difference was not statistically significant.Operative duration(266.79±69.39 vs.277.32±90.23 min,P=0.913)and volume of blood loss(8.88±12.37 vs.16.68±34.84 mL,P=0.758)were similar between two groups.MPCH group had a significantly higher number of drainage tubing than SPCH group(11 vs.7;P=0.0009).One child in SPCH group developed stenosis after hepaticojejunostomy.During follow-ups,no other complications occurred.Conclusions SPCH is as safe and effective as MPCH for choledochal cysts.It helps to lower the difficulty of single-incision laparoscopy.