完全腹腔镜与传统腹腔镜手术治疗婴儿胆总管囊肿的对比研究

A comparative study of total laparoscopic and traditional laparoscopic surgery for choledochal cyst in infants

目的对比分析完全腹腔镜与传统腹腔镜手术治疗婴儿胆总管囊肿的安全性及疗效。方法回顾性分析2012年6月至2020年12月行传统腹腔镜胆总管囊肿根治术46例与完全腹腔镜胆总管囊肿根治术62例的临床资料,对比分析两组手术时间、出血量、恢复进食时间、术后1个月总胆红素(total bilirubin,TB)、直接胆红素(direct bilirubin,DB)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)及天门冬氨酸氨基转移酶(aspartate aminotransferase,AST),术后住院时间、胆漏、远期肠梗阻发生率。结果完全腹腔镜组较传统腹腔镜组在手术时间[185.5(175.0,200.0)vs.194.5(184.8,210.0)min]、术后1个月TB、DB、ALT及AST、胆漏(3.2%vs.2.2%)、远期肠梗阻发生率(0 vs.4.3%)方面差异无统计学意义(P>0.05),在术后出血量[5(4.5,10)vs.10(5,10)ml]、恢复进食时间[6.0(5.4,7.0)vs.6.5(6.0,7.0)d]、术后住院时间[10(9.8,11.3)vs.11(11,12)d]方面均优于传统腹腔镜组,差异有统计学意义(P<0.05)。结论完全腹腔镜胆总管囊肿根治术是安全、可行的,创伤更小,术后恢复更快,未增加围手术期及远期并发症发生率,可临床推广。

Objective To compare and analyze the safety and efficacy of total laparoscopy and traditional laparoscopy in the treatment of choledochal cysts in infants.Methods The clinical data of 46 cases with traditional laparoscopic choledochal cyst radical resection and 62 cases with total laparoscopic choledochal cyst radical resection from Jun.2012 to Dec.2020 were retrospectively analyzed,and the operation time,blood loss,feeding recovery time,postoperative 1 month TB,DB,ALT and AST,postoperative hospital stay,incidence of bile leakage and long-term intestinal obstruction were compared between the two groups.Results There was no statistically significant difference(P>0.05).in operation time[185.5(175.0,200.0)vs.194.5(184.8,210.0)min],postoperative 1 month TB,DB,ALT and AST,bile leakage(3.2%vs.2.2%),and long-term intestinal obstruction(0 vs.4.3%)between the total laparoscopic group(62 cases)and the traditional laparoscopic group(46 cases).Total laparoscopic group had significantly shorter postoperative blood loss[5(4.5,10)vs.10(5,10)ml],time to oral intake[6.0(5.4,7.0)vs.6.5(6.0,7.0)d]and postoperative hospital stay[10(9.8,11.3)vs.11(11,12)d].Statistically significant difference(P<0.05).Conclusion Total laparoscopic choledochal cyst radical resection is safe and feasible,with less trauma,faster postoperative recovery,no increase in the incidence of perioperative and long-term complications,and can be clinically promoted.