腹腔镜胆总管囊肿根治术后中远期并发症分析及治疗经验总结

Analysis of middle/long-term complications after laparoscopic choledochal cyst radical excision: a summary of treatment experiences

目的探讨分析单中心应用腹腔镜下胆总管囊肿切除,肝管空肠Roux-Y吻合术治疗先天性胆总管囊肿,术后中远期并发症的种类及发病率,以及应对策略及预后。方法回顾性分析浙江大学医学院附属儿童医院2012年3月至2018年6月期间完成的378例腹腔镜胆总管囊肿根治术的临床资料,其中男72例,女306例。术后中远期并发症纳入标准为术后14d后出现或仍存在的并发症。结果378例患儿中,有31例出现术后中远期并发症,胆漏9例,占总例数的2.4%,其中8例经保守治疗后治愈,吻合口狭窄7例,占总例数的1.9%,其中5例接受了腹腔镜下吻合口重建术,胰腺炎5例,占总例数的1.3%,经保守治疗治愈,非胆汁性腹水3例,占总例数的0.8%,经保守治疗治愈,肝功能异常3例,占总例数的0.8%,经保守治疗治愈,肠粘连肠梗阻2例,占总例数的0.5%,经保守治疗治愈,腹内疝1例,占总例数的0.3%,经剖腹手术治愈,应激性胃痉挛1例,占总例数的0.3%,经保守治疗治愈。结论腹腔镜先天性胆总管囊肿根治术在国内经过十余年的发展推广,已逐渐成为各大小儿外科中心的常规术式。在完善改良临床手术操作的同时,也在加强对中远期并发症的随访,不断总结经验,减少并发症的发生,寻找最佳的并发症应对方案,降低并发症带来的不良后果,指导形成围手术期的治疗规范。

Objective To explore the middle/long-term complications of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy at a single institute.Methods Retrospective analyses were performed for 378 cases from March 2012 to June 2018.There were 72 boys and 306 girls.Middle/long-term complications occurred after Day 14 postoperatively.Results Thirty-one cases developed middle/long-term complications,included biliary leakage (n=9,2.4%),anastomotic stenosis (n=7,1.9%),pancreatitis (n=5,1.3%),non-bile ascites (n=3,0.8%),liver dysfunction (n=3,0.8%),intestinal adhesion & obstruction (n=2,0.5%),intraperitoneal hernia (n=1,0.3%) and stress gastric spasm (n=1,0.3%).Conclusions After over a decade of development,laparoscopic correction of congenital choledochal cyst has become a routine procedure at many domestic pediatric surgical institutes.Clinicians should not only focus on ameliorating surgical procedures,but also pay great attention to the follow-up of middle/long-term complications for enriching experiences and reducing the incidence of complications.