杂交经脐单切口与传统腹腔镜手术治疗小儿胆总管囊肿的对比研究

Hybrid transumbilical single incision versus conventional laparoscopy for choledochal cyst in children

目的对比分析杂交经脐单切口与传统腹腔镜手术治疗小儿胆总管囊肿的手术疗效。方法回顾性分析2017年1月至2019年12月行杂交经脐单切口腹腔镜胆总管囊肿切除+肝管空肠Roux-en-Y吻合术(研究组)治疗的25例胆总管囊肿患儿,及31例行传统腹腔镜胆总管囊肿切除+肝管空肠Roux-en-Y吻合术(对照组)治疗的胆总管囊肿患儿的临床资料。对比分析两组术后排气时间、胃管保留时间、引流管留置时间、术后住院时间,及术前、术后肝功能及炎症指标水平差异。分类变量以数字记录,采用卡方检验分析。计量资料用Mean±SD表示。患儿年龄、囊肿直径采用两独立样本t检验,患儿性别、囊肿分型和临床症状(包括黄疸、腹痛、腹部包块)采用行×列表分析,肝功能比较采用重复测量的方差分析。术前及术后第7天实验室检查结果比较采用配对t检验分析。白细胞计数、超敏C反应蛋白比较采用重复测量的方差分析。结果研究组术后排气时间为(1.5±0.6)d,胃管保留时间为(3.9±0.8)d,较对照组(1.9±0.7)d和(4.7±1.3)d均明显缩短,且差异均有统计学意义(P均<0.05)。研究组术后第1天白细胞计数和超敏C反应蛋白水平为(11.28±2.98)×10^(9)/L和(21.32±11.74)mg/L,较对照组(14.15±4.02)×10^(9)/L和(31.80±27.61)mg/L显著降低,且差异均有统计学意义(P均<0.05)。结论杂交经脐单切口腹腔镜胆总管囊肿切除+肝管空肠Roux-en-Y吻合术治疗小儿先天性胆总管囊肿是安全、可行的,未增加患儿围手术期并发症发生率,且患儿术后炎症反应明显减轻、胃肠功能恢复速度显著加快,可以在临床推广。

Objective To compare the effect of hybrid transumbilical single incision versus conventional laparoscopy for choledochal cyst in children.Methods For this retrospective study,clinical data were reviewed for children of choledochal cyst undergoing hybrid single incision laparoscopic resection plus Roux-en-Y hepaticojejunostomy(observation group,n=25)and conventional laparoscopic resection plus Roux-en-Y hepaticojejunostomy(control group,n=31).Two groups were compared with regards to perioperative parameters,duration of drainage and gastric tube,liver function,inflammatory parameters and immunoglobulin levels.Results No statistically significant differences existed in operative duration,duration of abdominal drainage tube,postoperative hospital stay or incidence of complications.The flatus-passing time[(1.5±0.6)vs.(1.9±0.7)days,P=0.033]and duration of gastric tube[(3.9±0.8)vs.(4.7±1.3)days,P=0.008]significantly decreased in observation group than those in control group.At Day 1 postoperatively,leukocyte count(P=0.04)and hypersensitive C-reactive protein(P=0.027)were significantly lower in observation group than those in control group.Conclusions Hybrid single incision laparoscopic resection plus Roux-en-Y hepaticojejunostomy is both safe and feasible in the treatment of choledochal cyst with the advantage of mini-invasiveness,cosmetic outcomes and fewer perioperative complications.As compared with conventional surgery,hybrid procedure offers significantly reduced inflammatory responses and faster recovery of gastrointestinal function.Hybrid single incision laparoscopic resection plus Roux-en-Y hepaticojejunostomy is a novel surgical approach for congenital choledochal cyst and should be widely applied in clinical practice.