经脐单一切口腹腔镜手术治疗小儿胆总管囊肿的疗效及对炎性因子的影响

Laparoscopy via single umbilical incision for children with choledochal cyst and its influence on inflammatory cytokines

目的探讨小儿胆总管囊肿采用经脐单一切口腹腔镜手术治疗的疗效及手术前后炎性因子水平的变化。方法41例胆总管囊肿患儿,17例行传统四孔腹腔镜囊肿切除及Roux-en-Y肝管空肠吻合术者为对照组,24例行经脐单一切口腹腔镜囊肿切除及Roux-en-Y肝管空肠吻合术者为观察组。记录2组切口长度、手术时间、术中出血量等;分别于术前及术后7d检测2组肝功能、炎性因子;比较2组术后7d并发症发生情况。结果观察组切口长度[(2.01±0.45)cm]较对照组[(6.34±1.57)cm]短,手术时间[(3.46±0.67)h]较对照组[(2.78±0.71)h]长(P<0.05),术中出血量、留置引流管时间、术后进食时间、住院时间与对照组比较差异均无统计学意义(P>0.05);观察组、对照组术后7d谷丙转氨酶[(36.94±7.38)、(38.76±7.44)u/L]、谷草转氨酶[(33.71±8.04)、(32.91±7.97)u/L]、γ-谷氨酰转肽酶[(41.93±10.07)、(39.48±9.64)u/L]、总胆红素[(14.36±5.17)、(15.11±5.26)μmol/L]、直接胆红素[(6.37±1.34)、(6.21±2.05)μmol/L]水平均低于术前[观察组:(147.36±23.17)u/L、(151.47±24.38)u/L、(243.92±55.89)u/L、(87.39±12.17)μmol/L、(55.91±11.37)μmol/L;对照组:(145.18±22.94)u/L、(150.77±22.76)u/L、(239.86±56.16)u/L、(88.06±11.91)μmol/L、(55.43±10.67)μmol/L](P<0.05),2组术前、术后组间比较差异无统计学意义(P>0.05);观察组、对照组术后7d高敏C反应蛋白[(5.19±1.38)、(4.97±1.44)mg/L]、白细胞介素-6[(50.39±9.66)、(49.81±9.53)ng/L]、白细胞介素-8[(12.34±4.06)、(13.01±3.84)ng/L]均低于术前[观察组:(12.19±3.67)mg/L、(68.37±10.55)ng/L、(20.02±4.39)ng/L;对照组:(12.26±3.58)mg/L、(69.18±10.67)ng/L、(19.86±4.41)ng/L](P<0.05),2组术前、术后组间比较差异无统计学意义(P>0.05);术后7d,2组均未发生胆漏、胆管炎、切口疝、吻合口狭窄等并发症。结论经脐单一切口腹腔镜手术治疗小儿胆总管囊肿切口小,安全性高,且不增强炎性反应,对肝功能的改善与传统四孔腹腔镜法相近。

Objective To investigate the surgical outcome of laparoscopy via single umbilical incision for children with choledochal cyst and the changes of inflammatory cytokines before and after operation.Methods In 41children with choledochal cyst,24underwent laparoscopic cyst excision via a single umbilical incision and Roux-en-Y hepatoenterostomy(observation group)and 17underwent traditional four-port laparoscopic cyst excision and Roux-en-Y hepatoenterostomy(control group).The incision length,operative time and intraoperative blood loss were recorded.The liver function and inflammatory cytokines were detected and compared between two groups before and on postoperative day 7.The complications were observed on postoperative day 7.Results The incision was significantly smaller in observation group((2.01±0.45)cm)than that in control group((6.34±1.57)cm),the operative time was significantly longer in observation group((3.46±0.67)h)than that in control group((2.78±0.71)h)(P<0.05).There were no significant differences in the intraoperative blood loss,the time of indwelling drainage,the time of oral feeding after operation and the hospital stay between two groups(P>0.05).The levels of glutamic pyruvic transaminase((36.94±7.38),(38.76±7.44)u/L),glutamic oxaloacetic transaminase((33.71±8.04),(32.91±7.97)u/L),gamma-glutamyl transferase((41.93±10.07),(39.48±9.64)u/L),total bilirubin((14.36±5.17),(15.11±5.26)μmol/L)and direct bilirubin((6.37±1.34),(6.21±2.05)μmol/L)in observation and control groups were significantly lower on postoperative day 7than those before operation(observation group:(147.36±23.17)u/L,(151.47±24.38)u/L,(243.92±55.89)u/L,(87.39±12.17)μmol/L,(55.91±11.37)μmol/L;control group:(145.18±22.94)u/L,(150.77±22.76)u/L,(239.86±56.16)u/L,(88.06±11.91)μmol/L,(55.43±10.67)μmol/L)(P<0.05),and showed no significant differences between two groups both before and after operation(P>0.05).The levels of high-sensitivity C-reactive protein((5.19±1.38),(4.97±1.44)mg/L),interleukin-6((50.39±9.66),(49.81±9.53)ng/L)and interleukin-8((12.34±4.06),(13.01±3.84)ng/L)on postoperative day 7in observation and control groups were significantly lower than those before operation(observation group:(12.19±3.67)mg/L,(68.37±10.55)ng/L,(20.02±4.39)ng/L;control group:(12.26±3.58)mg/L,(69.18±10.67)ng/L,(19.86±4.41)ng/L)(P<0.05),and showed no significant differences between two groups both before and after operation(P>0.05).No biliary leakage,cholangitis,incisional hernia or anastomotic stenosis occurred in two groups on postoperative day 7.Conclusion With small incision,laparoscopy via single umbilical incision is safe for children with choledochal cyst,and it could reduce the levels of inflammatory cytokines and has similar effect on improving liver function as traditional four-port laparoscopic cyst excision.