完全腹腔镜手术治疗成人先天性胆总管囊肿

Totally laparoscopic surgical treatment of congenital choledochal cysts in adult patients

目的评估腹腔镜手术治疗成人先天性胆总管囊肿（congenital choledochal cysts, CCC）的可行性。方法本组36例成人CCC患者Todani分型Ⅰ型31例，Ⅳ型5例。将36例患者分为两组，腹腔镜手术治疗组18例，开腹手术组18例。结果围手术期无死亡病例，所有患者均获得完整随访。腹腔镜组与开腹组的手术时间分别为（212±43）rain及（135±20）min，术中失血量为（75±20）ml及（150±49）ml，差异均有统计学意义（分别t=6．875、6．000，P〈0．05）。术后肠道功能恢复时间（65±15）及（944-12）h，腹腔引流管留置时间（72±20）h及（89±26）h，术后住院时间（5．8±1．4）d及（8．9±0．9）d，差异均有统计学意义（t=6．444、2．199、7．908，P〈0．05）。远期并发症中腹腔镜手术组有l例反流性胆管炎，开腹组有1例胆肠吻合口狭窄，肝内复发结石。结论腹腔镜成人先天性胆总管囊肿切除和胆肠吻合术安全可行。

Objective To evaluate feasibility of totally laparoscopic surgical treatment of congenital choledochal cysts（CCC） in adult patients. Methods The clinical data of 36 adult CCC patients were analyzed retrospectively. In this study there were 31 type I cases and 5 type Ⅳ cases, divided into laparoscopic operation group （n = 18） and open operation group （n = 18）. Results There were no death cases in perioperative period and all patients were followed up. The total operative time of laparoscopy group compared with open group respectively was （212 ± 43） min and （ 135 ±20） min （ P 〈 O. 05 ）, the volume of blood loss during operation was （ 75 ± 20） ml and （ 150 ± 49 ） ml, （ respectively t = 6. 875, 6. 000, P 〈 0. 05 ）. Postoperative recovery time of intestinal function was （65 ± 15 ） h vs （ 94 ± 12） h, celiac drainage tube indwelling time was （72 ± 20） h vs （ 89 ±26 ） h, postoperative hospital stay was （ 5.8 ± 1.4 ） d vs （ 8.9 ± 0. 9） d, （ respectively t = 6. 444, 2. 199, 7. 908 ,P 〈 O. 05 ）. One case suffered from reflux cholangitis in the laparoscopic group, 1 case of choledochojejunostomy stricture and recurrence of intrahepatic calculi in the open group. Conclusion Laparoscopic cystectomy and cholangiojejunostomy for congenital choledochal cyst in adults is safe and feasible.