经脐单部位三通道腹腔镜胆总管囊肿根治术的临床体会(附48例报告)

Transumbilical single-site laparoscopic choledochal cyst excision with three-channels:with a report of 48 cases

目的:总结经脐单部位三通道腹腔镜胆总管囊肿根治性切除术治疗先天性胆总管囊肿的手术经验。方法:回顾分析2015年6月至2017年4月收治的48例先天性胆总管囊肿患儿的临床资料,其中男13例,女35例;15个月~8岁,平均(2.3±0.7)岁,患儿均行B超、CT及MRCP等检查,按Todani分型分为:Ⅰ型32例,Ⅳ型16例。术后门诊随访。结果:48例患儿均经脐部单一切口完成腹腔镜胆总管囊肿根治术,手术时间170~240 min,平均(194.40±13.20)min;术中出血量6~14 ml,平均(8.70±1.30)ml,无术中或术后输血及中转开放手术。术后72 h复查B超,无腹腔积液后拔除腹腔引流管。术后随访6个月,无相关术后并发症发生。结论:经脐单部位三通道腹腔镜胆总管囊肿根治术可达到传统腹腔镜手术的效果,脐部切口更加隐蔽美观,但其学习曲线较长,术者需积累一定经验并增加熟练程度。

Objective：To summarize the technical experience and skill in laparoscopic total cyst excision for choledochal cyst through single incision with three channels. Methods：From Jun. 2015 to Apr. 2017,a total of 48 choledochal cyst children were enrolled. There were 13 males and 35 females. Their average age was（2. 3 ± 0. 7） years（ ranged 15 months to 8 years）. The Todani types of choledochal cyst were type Ⅰ（ n = 32） and type Ⅳ（ n = 16） according to the diagnostic criteria of ultrasound type B,CT and magnetic resonance cholangiopancreatography. Results： Cystic excision with hepaticoenterostomy was accomplished laparoscopically in48 cases through single umbilical incision. Average duration of operation was（ 194. 40 ± 13. 20） min（ range,170-240 min）,average intraoperative bleeding was（8. 70 ± 1. 30） ml（ range,6-14 ml） without blood transfusion or conversion to laparotomy. The postoperative ultrasound type B 72 h later showed no abdominal effusion,and the intraperitoneal drainage tube was removed. There was no postoperative complications during follow-up for 6 months. Conclusions：Laparoscopic choledochal cyst excision through the single umbilical incision with three-channels has the same effect with the traditional laparoscopic surgery. The umbilical incision is more subtle and beautiful,but the learning curve is relatively long,the operators need more proficiency.