腹腔镜联合胆道镜治疗儿童先天性胆管扩张症的临床应用

Clinical application of laparoscopy combined withcholedochoscopy for children with congenital biliary dilatation

目的:探讨腹腔镜联合胆道镜手术治疗儿童先天性胆管扩张症的临床疗效。方法:收集2019年12月至2023年12月接受腹腔镜根治手术的98例先天性胆管扩张症患儿的临床资料,根据术中胆道检查方法分为三组,腹腔镜组(n=38)行腹腔镜手术,胆道造影组(n=28)于腹腔镜术中行胆道造影检查,胆道镜组(n=32)于腹腔镜术中行胆道镜检查,术前均常规行磁共振胰胆管成像。收集患儿性别、年龄、囊肿类型、囊肿直径、囊肿长度、术前磁共振胰胆管成像是否发现结石与胆道异常、术中新发现结石、胆管变异、胆管狭窄及术后胆漏、胆管炎、胰腺炎、吻合口狭窄情况。结果:三组患儿性别、年龄、囊肿直径、囊肿长度、囊肿类型、术前磁共振胰胆管成像发现结石与胆道异常情况差异均无统计学意义(P>0.05)。胆道镜组新发现结石率更高(28.1%,9/32),胆道造影组发现胆道变异率更高(21.4%,6/28),差异有统计学意义(P<0.05)。三组患儿术后总体并发症发生率差异有统计学意义(P<0.05),其中胆道镜组术后并发症发生率最低(3.1%,1/32)。结论:腹腔镜联合胆道镜探查能发现更多“遗漏”的结石且术后并发症发生率较低,同时避免了儿童辐射暴露的风险,值得临床进一步实践应用。

Objective:To investigate the clinical effect of laparoscopy combined with choledochoscopy in the surgical treatment of congenital biliary dilatation in children.Methods:The clinical data of 98 children with congenital biliary dilatation who underwent laparoscopic radical surgery from Dec.2019 to Dec.2023 were collected and divided into three groups based on the intraoperative biliary examination methods.The laparoscopic group(n=38)only underwent laparoscopic surgery,the cholangiography group(n=28)underwent intraoperative cholangiography in laparoscopic surgery,and the choledochoscopy group(n=32)underwent choledochoscopy in laparoscopic surgery.All children underwent routine magnetic resonance cholangiopancreatography before surgery.The collected data i ncluded gender,age,cyst type,cyst diameter,cyst length,presence of stones and bile duct abnormalities detected in preoperative magnetic resonance cholangiopancreatography,identification of new stones during surgery,bile duct variations,bile duct stenosis,postoperative bile leakage,cholangitis,pancreatitis,and anastomotic stenosis.Results:There were no significant differences in gender,age,cyst diameter,cyst length,cyst type,stones and biliary tract abnormalities found by preoperative magnetic resonance cholangiopancreatography among the three groups(P>0.05).The choledochoscopy group found more new stones(28.1%,9/32),the cholangiography group detected more biliary variations(21.4%,6/28),the differences were statistically significant(P<0.05).The total complication rate differed among the three groups(P<0.05),the choledochoscopy group had the lowest postoperative complication rate(3.1%,1/32).Conclusions:Laparoscopy combined with choledochoscopy can detect more"missed"stones with lower postoperative complication rates,while avoiding the risk of radiation exposure in children,which is worthy of further application in clinical practice.