腹腔镜治疗小儿肝囊肿的临床研究

Efficacies and feasibility of laparoscopic treatment for hepatic cysts in children

目的分析小儿肝囊肿腹腔镜治疗的可行性及效果。方法回顾性分析自2010年12月至2013年12月收治肝囊肿7例患儿的临床资料。其中，男3例，女4例；年龄12d～3岁7个月；全部为单发囊肿。全部患儿行腹腔镜手术（经脐部单切口腹腔镜5例），及术中胆道造影。1例患儿行腹腔囊肿切除术，4例患儿行腹腔镜囊肿开窗术，2例患儿行腹腔镜囊肿胆囊吻合术。结果无术中中转开腹。手术时间90～150min，平均（102．9±23．6）min。出血量2～5ml。无死亡病例，无创面出血，腹腔感染，腹腔积液等并发症。患儿术后3～7d出院。术后每3个月门诊复查超声及生化指标，全部患儿肝功能及胆红素正常。囊肿切除及开窗术患儿无囊肿复发，胆囊吻合术患儿囊肿明显减小，无不适症状；无胆道感染、腹腔感染积液等并发症。结论小儿肝囊肿应用腹腔镜及经脐部单切口腹腔镜治疗是安全有效的，如果囊肿与肝内胆管相通可考虑行囊肿胆囊吻合术。

Objective To review and evaluate the efficacies and feasibility of laparo-pscopic treatment for hepatic cysts in children. Methods From December 2010 to December 2013, 7 patients with simple cysts underwent laparoscopy. There were 3 boys and 4 girls with an age range of 12 days to 43 months The operative procedures included cystectomy （n = 1 ）, fenestration （n = 4 ） and cystocholecystostomy （n = 2）. Results All surgeries were completed laparoscopically without open operation or complications. The mean operative duration was （102. 9 ± 23. 6） （90-150） minutes and the intraoperative volume of blood loss 2-5 ml. None had a postoperative onset of hemorrhage, mortality, bile leak, increased cyst size or re-operation. The postoperative hospital stay was 3 to 7 days. The postoperative follow-up period was every 3 months. Postoperative liver function tests and serum bilirubin levels were normal. Conclusions Single-incision laparoscopic cysto-cholecystostomy is preferred for hepatic portal cysts with biliary communication. And laparoscopic cystectomy or fenestration is feasible for cysts without biliary communication.