腹腔镜手术与小切口开放手术治疗儿童胆总管囊肿的效果及对患儿胃肠功能、创伤反应的影响

Effect of Laparoscopic Surgery and Small Incision Open Surgery in the Treatment of Choledochal Cyst in Children and Its Influence on Gastrointestinal Function and Trauma Response

目的:对比腹腔镜手术与小切口开放手术治疗儿童胆总管囊肿(CC)的效果。方法:收集2019年4月—2022年4月漯河市第二人民医院收治的100例CC患儿,按手术方案不同分为A组(n=50)和B组(n=50)。B组接受小切口CC切除术治疗,A组接受腹腔镜辅助CC切除术治疗。对比两组手术指标、胃肠功能恢复指标、肝功能指标[谷草转氨酶(AST)、总胆红素(TBIL)、谷丙转氨酶(ALT)]、创伤反应指标[皮质醇(Cor)、丙二醛(MDA)、促肾上腺皮质激素(ACTH)]水平、并发症发生率。结果:与B组相比,A组切口长度、引流管拔除时间、住院时间更短,术中失血量更少,手术时间更长,差异均有统计学意义(P<0.05);与B组相比,A组术后首次进食时间、术后首次排便时间均更短,差异均有统计学意义(P<0.05);术后1 d、3 d,两组AST、ALT、TBIL水平较术前均降低,且A组均低于B组,差异均有统计学意义(P<0.05);术后1 d、3 d,两组血清Cor、MDA、ACTH水平较术前均升高,但A组均低于B组,差异均有统计学意义(P<0.05)。A组并发症发生率为2.00%(1/50),与B组的12.00%(6/50)相比,差异无统计学意义(P>0.05)。结论:与小切口开放手术治疗CC患儿相比,应用腹腔镜辅助CC切除术治疗于优化手术指标、胃肠功能恢复指标、肝功能指标方面更具优势,且对机体创伤反应影响更小,但手术时间略长。

Objective:To compare the effect of laparoscopic surgery and small incision open surgery in the treatment of choledochal cyst(CC)in children.Method:A total of 100 children with CC who admitted to Luohe Second People's Hospital from April 2019 to April 2022 were collected and divided into group A(n=50)and group B(n=50)according to different surgical plans.Group B was given small incision CC resection,and group A was given laparoscopic assisted CC resection.The operation indexes,gastrointestinal function recovery indexes,liver function indexes[aspartate aminotransferase(AST),total bilirubin(TBIL),alanine aminotransferase(ALT)],trauma response indexes[cortisol(Cor),malondialdehyde(MDA),adrenocorticotropic hormone(ACTH)]and the incidence of complications were compared between two groups.Result:Compared with group B,group A had shorter incision length,drainage tube removal time,hospitalization time,less intraoperative blood loss and longer operation time,the differences were statistically significant(P<0.05).Compared with group B,the time of first eating and first defecation after operation in group A were shorter,the differences were statistically significant(P<0.05).At 1 d and 3 d after operation,the AST,ALT and TBIL levels of two groups were lower than those before operation,and the indexes in group A were lower than those of group B,the differences were statistically significant(P<0.05).At 1 d and 3 d after operation,the serum Cor,MDA and ACTH levels in two groups were higher than those before operation,but the indexes in group A were lower than those of group B,the differences were statistically significant(P<0.05).The incidence of complications in group A was 2.00%(1/50),compared with 12.00%(6/50)in group B,the difference was not statistically significant(P>0.05).Conclusion:Compared with small incision open surgery for children with CC,laparoscopic assisted CC resection has more advantages in optimizing surgical indicators,gastrointestinal function recovery indicators and liver function indexes,and has less impact on body trauma response,but the operation takes a little longer.