腹腔镜Kasai手术治疗胆道闭锁合并肝右动脉变异

Efficacy of laparoscopic Kasai procedure for treating biliary atresia with an aberrant right hepatic artery

目的探讨腹腔镜Kasai手术治疗小儿胆道闭锁合并肝右动脉变异的治疗效果。方法收集2014年1月至2021年8月在淮安妇幼保健院行腹腔镜Kasai手术的8例胆道闭锁合并肝右动脉变异的Ⅲ型胆道闭锁患儿的临床资料,其中男5例,女3例;入院时平均年龄78.1 d;平均体重5.9 kg。手术采用四孔法,在变异肝右动脉和门静脉右支之间游离胆总管,牵拉至肝门。游离并切除肝门纤维块,完成腹腔镜Kasai手术。随访并观察患儿治疗效果。结果所有患儿均经腹腔镜手术,无特殊手术并发症。平均手术时间为235 min,平均出血量为12.8 ml,术后平均随访时间为32.1个月。6例患儿术后4个月内总胆红素降至正常。另外2例患儿胆红素术后显著下降,但由于并发胆管炎再次升高,持续观察中并使用抗生素、熊去氧胆酸和激素治疗。结论对于胆道闭锁合并肝右动脉变异患儿,腹腔镜Kasai手术可安全实施,应注意在变异肝右动脉和右门静脉支之间充分游离胆总管。

Objective To devise a management strategy for biliary atresia(BA)with an aberrant right hepatic artery through laparoscopic Kasai procedure in children.Methods Between January 2014 and August 2021,8 consecutive typeⅢBA children with an aberrant right hepatic artery underwent laparoscopic Kasai procedure.There were 5 boys and 3 girls with a mean admission age of 78.1 days and a mean body weight of 5.9 kg.Common bile duct was mobilized between right hepatic artery and right branch of portal vein and then lifted to hepatic hilum.After resecting biliary remnant,laparoscopic Kasai was performed via 4 Trocars.Results All of them survived without any intraoperative complication.Mean operative duration was 235 min and mean volume of blood loss 12.8 ml.No uncontrollable intraoperative hemorrhage occurred.Mean follow-up period was 32.1 months.Total/direct bilirubin normalized at Month 4 post-operation(n=6).In another 2 cases,postoperative level of bilirubin dropped markedly and then rebounded because of recurrent cholangitis.Besides ongoing observations,antibiotics,ursodeoxycholic acid and prednisolone were offered.Conclusions With refined laparoscopic skills,common bile duct may be safely mobilized between right hepatic artery and right branch of portal vein for infants with typeⅢBA associated with an aberrant right hepatic artery.And laparoscopic Kasai is both safe and feasible.