腹腔镜治疗成人Ⅳ型先天性胆管扩张症的安全性和疗效

Laparoscopic surgery in treatment of type IV congenital biliary dilatation in adults:safety and efficacy

目的探讨腹腔镜手术治疗成人Ⅳ型先天性胆管扩张症(CBD)的安全性和疗效。方法回顾性分析湖南省人民医院2010年1月至2019年1月行完整囊肿切除+胆管空肠Roux-en-Y吻合术治疗的63例成人Ⅳ型CBD患者临床资料,其中腹腔镜组23例,开腹组40例。采用t检验比较两组患者手术时间、术中出血量、术后排气时间和住院时间的差异,采用χ^2检验比较两组患者术后并发症的差异。结果腹腔镜组23例成人Ⅳ型CBD患者,其中男性4例,女性19例,年龄(29.9±14.0)岁;开腹组40例,男性7例,女性33例,年龄(30.9±15.7)岁。腹腔镜组与开腹组患者手术时间分别为(207.1±21.7)min和(158.8±23.3)min,术中出血量分别为(189.6±150.5)ml和(266.0±119.5)ml,术后排气时间分别为(72.8±16.0)h和(87.0±17.0)h,术后住院时间分别为(9.8±3.2)d和(11.9±3.7)d,两组比较差异均有统计学意义(均P<0.05)。两组患者在吻合口狭窄、胆漏、切口感染等术后并发症方面,差异无统计学意义(均P>0.05)。结论腹腔镜下治疗成人Ⅳ型CBD安全可行,具有微创、出血量少、胃肠功能恢复较快、住院时间短等优点。

Objective To study the safety and efficacy of laparoscopic surgery in treatment of adult type IV congenital biliary dilatation(CBD).Methods The clinical data of 63 adult patients with type IV CBD who underwent complete cystectomy and Roux-en-Y choledochojejunostomy at Hunan Provincial People’s Hospital from January 2010 to January 2019 were retrospectively studied.There were 23 patients in the laparoscopy group and 40 patients in the laparotomy group.T-test was used statistically to compare the differences in operation time,intraoperative blood loss,postoperative time to fist flatus,and hospital stay between groups.Chi-square test was used to statistically compare postoperative complications between groups.Results In the laparoscopy group,there were 4 males and 19 females,aged(29.9±14.0)years,while in the laparotomy group,there were 7 males and 33 females,aged(30.9±15.7)years old.The operation times of the laparoscopy and laparotomy groups were(207.1±21.7)min versus(158.8±23.3)min,respectively.The intraoperative bleeding volume was(189.6±150.5)ml versus(266.0±119.5)ml,respectively.The postoperative time to first flatus was(72.8±16.0)h versus(87.0±17.0)h respectively.The postoperative hospital stay was(9.8±3.2)d versus(11.9±3.7)d,respectively.There were significant differences between the two groups(all P<0.05).There was no significant difference in postoperative complications,including anastomotic stricture,bile leakage and incision infection between groups(all P>0.05).Conclusions Laparoscopic surgery to treat adult type IV CBD was safe and feasible.It had the advantages of minimal invasiveness,less bleeding,rapid recovery of gastrointestinal function,and a short hospital stay.