腹腔镜肝门空肠吻合术治疗小儿胆道闭锁的临床观察

Clinical observation of laparoscopic hepaticojejunostomy for pediatric biliary atresia

目的:探讨腹腔镜肝门空肠吻合术治疗小儿胆道闭锁的临床疗效。方法:回顾分析2011年1月至2012年12月收治的12例Ⅰ、Ⅱ型胆道闭锁症患儿的临床资料,分析其术中情况、术后并发症、术后胆汁引流情况及住院时间。结果:12例患儿均顺利完成腹腔镜手术,手术时间平均(3.5±1.2)h,出血量平均(11.2±1.6)ml。无术中、术后(腹腔感染、肠漏等)并发症发生。术后患儿黄疸症状明显减轻,血生化各项指标较术前明显降低,差异有统计学意义(P<0.05)。结论:腹腔镜肝门空肠吻合术治疗小儿胆道闭锁安全、有效,术野暴露更充分,可更清晰地显示肝门处的细微结构,如肝门纤维条索、门静脉及肝动脉等。术中不游离肝脏,对肝脏血供、下腔静脉回流影响小,对患儿打击小,术后肠蠕动恢复快,避免了术后肠梗阻的发生,间接降低了术后胆管炎的发生几率。

Objective：To investigate the clinical effects of laparoscopic hepaticojejunostomy for pediatric biliary atresia. Methods ：The clinical data of 12 children with type I or Ⅱ biliary atresia from Jan. 2011 to Dec. 2012 were retrospectively analyzed,including the intraoperative and postoperative complications, postoperative bile drainage and hospital stay. Results：All laparoscopic operations were successfully performed. The operative time was （ 3.5 ±1.2 ） h, intraoperative blood loss was （ 11.2 ± 1.6 ） ml without necessity for blood transfusion. No intraoperative and postoperative complications occurred, such as abdominal infection or intestinal leakage. Postoperative jaundice symptoms significantly reduced. The postoperative biochemical indicators significantly decreased compared with preoperative data （ P 〈 O. 05 ）. Conclusions： Laparoscopic hepaticojejunostomy for children with type I or ]I biliary atresia is feasible, safe and effective. The operative field can be fully exposed, the fine structure of hepatic porta such as hepatic portal fibrous bands, the portal vein and the hepatic artery, could be clearly showed. Liver is not been dissociated during the operation, so the influence on the blood supply of the liver and the reflux of inferior vena cava is little. With few trauma of child and quick recovery of postoperative peristalsis, this procedure avoids occurrence of postoperative intestinal obstruction, indirectly decreases the incidence of postoperative cholangitis.