腹腔镜手术治疗新生儿胆总管囊肿17例临床分析

Laparoscopy for Neonatal Choledochal Cyst:a Clinical Analysis of 17 Cases

目的总结腹腔镜手术治疗新生儿胆总管囊肿的诊治经验。方法回顾性分析江西省儿童医院2014年6月至2022年11月,腹腔镜手术住院治疗的17例新生儿胆总管囊肿患儿临床资料。患儿男8例,女9例,入院年龄(9.95±8.52)d,体重(3.38±0.48)kg;根据Todani分型Ⅰ型13例,Ⅳ型4例;囊肿最大直径(5.24±2.12)cm;多以黄疸(12/17)、产前超声诊断(7/17)、呕吐(3/17)就诊。结果17例新生儿均完成腹腔镜手术,其中1例患儿术后第6天肠管从脐部切口脱出行非计划再次手术。所有患儿出院前复查肝功能黄疸较术前有明显下降,差异有统计学意义(P<0.05),陶土样便者术后大便颜色转为正常;2例患儿出院前丙氨酸氨基转移酶较术前异常升高,其余患儿出院前丙氨酸氨基转移酶指标均在正常范围,门诊随访2周~2个月肝功能及黄疸均恢复正常。随访3~48个月,无吻合口狭窄、肠梗阻伴粘连、反流性胆管炎等并发症。结论新生儿期胆总管囊肿腹腔镜微创手术可有效控制和改善肝功能损伤、梗阻性黄疸、胆道炎症等并发症的发生,安全、可行。

Objective To summarize the experience of diagnosis and treatment of neonatal choledochal cyst by laparoscopy.Methods Clinical data of 17 cases of neonatal choledochal cyst treated by laparoscopic surgery in Jiangxi Children's Hospital from June 2014 to November 2022 were retrospectively analyzed,including 8 males and 9 femaleswith an average admission age of(9.95±8.52)d and body weight of(3.38±0.48)kg.According to Todani's classification,there were 13 cases of type Ⅰ and 4 cases of type Ⅳ.The maximum diameter of the cyst was(5.24±2.12)cm.Most of the neonates were admitted due to jaundice(12/17),prenatal ultrasound findings(7/17),and vomiting(3/17).Results All the 17 neonates completed laparoscopic surgery,and 1 case underwent unplanned re-operation on the 6th day after surgery due tobowel prolapse from the umbilical incision.After operation,the jaundice was significantly reducedinall the children(P<0.05),and the stool color returned to normal innewborns with acholic stool.Before discharge,the levels of alanine aminotransferase increased in 2 cases,and were in the normal range in other cases.The liver function and jaundice returned to normal after 2 weeks to 2 months of outpatient follow-up.There were no complications such as anastomotic stenosis,reflux cholangitis and intestinal obstruction with adhesion during 3-48 months of follow-up.Conclusion Laparoscopic surgery for neonatal choledochalcyst is effective,safe and feasible for controlling and improving the occurrence of liver function injury,obstructive jaundice,biliary tract inflammation and other complications.