腹腔镜与开放性肝管空肠吻合术治疗先天性胆总管囊肿的疗效比较

Laparoscopic Roux-en-Y hepatojejunostomy for children with choledochal cysts： intermediate-term fol- low-up results

目的比较腹腔镜与开放性肝管空肠吻合术治疗先天性胆总管囊肿的中期疗效，探讨腹腔镜下肝管空肠吻合术治疗先天性胆总管囊肿的可行性及安全性。方法回顾性分析2001年10月至2009年10月作者采取腹腔镜下肝管空肠吻合术治疗的218例先天性胆总管囊肿患儿临床资料，并将1993年9月至2001年9月行开放性肝管空肠吻合术的200例患儿作为对照，对其诊疗情况及术后恢复、随访情况进行比较。结果腹腔镜手术组与开放手术组手术时中位年龄分别为4．16岁（7d至18岁）、4．59岁（13d至17岁），中位随访时问分别为38个月、146个月，差异均无统计学意义；病例数超过35例时，腹腔镜组平均手术时间较前明显缩短（P〈0．01），至2009年，与开放手术组相比，平均手术时间无显著差异[（3．04±0．98）hVS（2．95±0．91）h，P=0．557）]。腹腔镜手术组术中平均失血量约（9．08±6．13）mL，而开放手术组约（35．33±33．29）mL，差异有统计学意义（P〈0．001）。腹腔镜手术组术后住院时间、恢复饮食时间及引流时间均较开放手术组明显缩短（P〈0．001），腹腔镜手术组术后并发症较开放手术组明显减少（P〈0．01）。结论腹腔镜下肝管空肠吻合术治疗先天性胆总管囊肿安全可行，其中期疗效与开放手术相似，甚至优于开放手术。

Objective Laparoscopic hepatojejunostomy （LH） for children with eholedochal cysts （CDC） has been gaining popularity recently. However, its safety and efficacy remain unknown . The purpose of this study was to evaluate the intermediate - term results of LH for CDC children. Methods We reviewed 218 patients who underwent LH between October 2001 and October 2009 and 200 patients who underwent open hepatojejunostomy （OH） between September 1993 and September 2001. Ultrasonography, upper gastraintesti- nal contrast studies, and laboratory tests were performed during the follow-up period. Age, operative blood loss, operative time, postoperative hospital stay, time to full feed, duration of drainage, postoperative complications, and perioperative laboratory tests were evaluated in both groups. Results The median follow-up periods of the LH and OH groups were 38 and 146 months, respectively. There was no significant difference in age be- tween the two groups. Interestingly, the operative time of the LH group decreased significantly with increasing number of cases （ P 〈 0.01 ）. The most recent operative time of the LH grotip did not differ from that of the OH group （ 3.04 vs. 2.95 h, P = 0.557 ）. The operative blood loss of the LH group was significantly less （ P 〈 0. 001 ）. The postoperative hospital stay, resumption of alimentation, and duration of drainage in the LH group were significantly shorter （P 〈0.001, respectively）. Two of 218 （0.9%） LH patients developed bile leak. This was significantly less than 11 of 200 （5.5 % ） in the OH group （P 〈 0.01 ）. The morbidities of LH group were significantly lower than those of the OH group. Postoperative liver function tests and serum amylase levels normalized in both groups （ P 〈 0. 001 ）. Conclusion Laparoscopic hepatojejunostomy is safe and effective. Its intermediate-term results are comparable to open surgery.