微创技术治疗儿童TodaniⅡ型胆总管囊肿经验总结

Experience of mini-invasive treatment for Todani typeⅡcholedochal cyst in children

目的总结微创技术治疗儿童TodaniⅡ型胆总管囊肿的临床经验。方法浙江大学医学院附属儿童医院普外科2012年3月至2019年12月间完成了517例胆总管囊肿根治术,其中512例为腹腔镜胆总管囊肿根治术,5例达芬奇机器人胆总管囊肿根治术。517例中有5例TodaniⅡ型胆总管囊肿,均纳入本研究,占总例数的0.97%(5/517),均为女性,年龄范围为4个月至12岁;2例患儿无临床症状,2例有右上腹疼痛,1例有右中上腹疼痛伴发热呕吐。本研究的5例患儿术前均接受了磁共振胆胰管成像(magnetic resonance cholangiopancreatography,MRCP)检查,3例提示为TodaniⅡ型胆总管囊肿,1例提示为TodaniⅠ型胆总管囊肿,1例提示为TodaniⅣ型胆总管囊肿;2例有明确胰胆合流异常。结果所有患儿均在术中确诊为TodaniⅡ型胆总管囊肿,手术时间范围为2.5~3.5 h,无术中中转开腹病例,无术中输血病例;术后恢复顺利,平均住院时间为12 d。术后病理学检查均提示为憩室型囊肿内壁内衬胆管上皮,部分囊壁可见透明样变,无癌变诊断。术后随访1~2年均未出现并发症。结论运用微创技术治疗TodaniⅡ型胆总管囊肿会因解剖结构差异给临床医生带来一定的困扰,达芬奇机器人技术在精细操作方面优于常规腹腔镜技术,尤其在微小胆管胆肠重建上,给术者带来的体感更佳。

Objective To summarize the clinical experience of mini-invasive technique for Todani typeⅡcholedochal cyst in children.Methods From March 2012 to December 2019,517 cases of radical resection of choledochal cyst were completed,including radical laparoscopic resection of choledochal cyst(n=512)and Da Vinci robotic radical resection of choledochal cyst(n=5).Todani typeⅡcholedochal cysts accounted for 0.97%(5/517)of the total number of cases.The age range was 4 to 144 months.Clinical symptoms were non-specific(n=2),right upper quadrant pain(n=2)and middle/upper quadrant pain with fever&vomiting(n=1).Magnetic resonance cholangiopancreatography(MRCP)confirmed a diagnosis of Todani typeⅡcholedochal cyst(n=3),Todani type I choledochal cyst(n=1)and Todani type IV choledochal cyst(n=1).Two cases had a definite abnormal pancreatobiliary junction.Results Todani typeⅡcholedochal cyst was intraoperatively diagnosed.The range of operative duration was 2.5 to 3.5 h.Postoperative recovery was smooth.There was neither any conversion into laparotomy nor intraoperative blood transfusion.The average hospital stay was 12 days.Postoperative pathological examination revealed that inner cyst wall was lined by biliary epithelium and some cyst walls displayed hyaline degeneration without cancerous transformation.No complications occurred during a postoperative follow-up period of 1 to 2 years.Conclusions Applying mini-invasive techniques for Todani typeⅡcholedochal cyst brings some troubles to surgeons due to differences in anatomical structures.And da Vinci robotic technique is superior to conventional laparoscopy in terms of finer and more convenient handling,especially for reconstructing tiny bile duct bile and intestine.