完全腹腔镜下手术治疗新生儿、小婴儿先天性胆总管囊肿70例

Total Laparoscopic Choledochal Cyst Excision for Congenital Choledochal Cysts in 70 Neonatal and Infant Patients

目的探讨完全腹腔镜下囊肿切除、肝管空肠Roux-en-Y吻合术治疗新生儿、小婴儿先天性胆总管囊肿的安全性及可行性。方法回顾性分析2016年12月~2021年7月70例先天性胆总管囊肿行完全腹腔镜下胆总管囊肿切除、肝管空肠Roux-en-Y吻合术的临床资料。手术年龄10~148 d,(61.7±26.8)d;体重2.6~7.6 kg,(4.7±1.2)kg。TodaniⅠ型58例(Ⅰa型54例,Ⅰb型2例,Ⅰc型2例),Ⅳa型12例。囊肿直径1.1~14.8 cm,中位数5.1 cm。40例(57.1%)产前超声诊断。47例(67.1%)术前有黄疸,11例合并大便颜色变浅,15例合并肝功能损害。结果手术时间135~240 min,(187.9±19.6)min;术中出血2~30 ml,中位数5 ml;术后进食时间4~14 d,中位数6 d;术后住院时间8~33 d,中位数10 d。术后胆肠吻合口漏3例,其中1例合并吻合口狭窄。术后随访7~62个月,中位数33个月。无肠梗阻、胆管炎和胰腺炎。结论完全腹腔镜下囊肿切除、肝管空肠吻合术治疗先天性胆总管囊肿是安全、可行的。

Objective To investigate the safety and feasibility of total laparoscopic choledochal cyst excision with Roux-en-Y hepatoenterostomy for congenital choledochal cysts in neonatal and infant patients.Methods Clinical data of 70 neonates or infants with congenital choledochal cyst who underwent total laparoscopic choledochal cyst excision between December 2016 and July 2021 in our hospital were analyzed retrospectively.The mean age was 61.7±26.8 days old(range,10-148 days old),and the mean weight was 4.7±1.2 kg(range,2.6-7.6 kg).The Todani types of the cysts were typeⅠ(n=58,Ⅰa-54,Ⅰb-2,Ⅰc-2)and typeⅣa(n=12).The diameter of cyst was 1.1-14.8 cm(median,5.1 cm).Forty(57.1%)patients were diagnosed by prenatal ultrasound.Before the operation,47(67.1%)patients had jaundice symptoms,11 had lighter stool color,and 15 had liver function damage.Results The mean operative time was 187.9±19.6 min(range,135-240 min).The median intraoperative blood loss was 5 ml(range,2-30 ml).The median initial feeding time was 6 days(range,4-14 days).The median postoperative hospital stay was 10 days(range,8-33 days).There were 3 cases of postoperative anastomotic leakage,1 of which was combined with anastomotic stenosis.The median follow-up period was 33 months(range,7-62 months).No intestinal obstruction,cholangitis or pancreatitis was observed during the follow-ups.Conclusion Total laparoscopic cyst excision with Roux-en-Y hepatoenterostomy for choledochal cyst in neonatal and infant patients is safe and feasible.