关键词: 先天性胆总管囊肿, 腹腔镜, 肝十二指肠吻合术, 肝管空肠Roux-en-Y吻合术, 改良胆肠袢式吻合术, 治疗

Abstract: Objective The aim of this study was to investigate the clinical efficacy of complete laparoscopic choledochal cyst resection followed by different biliary tract reconstructions. Methods 81 children with congenital choledochal cyst (CCC) were encountered in our hospital between January 2016 and May 2020, and all underwent complete laparoscopic choledochal cyst resection. As for biliary tract reconstruction, the hepaticoduodenostomy (HA) was done in 28 cases (group A), the hepatojejunal Roux-en-Y anastomosis (HR)was adopted in 30 cases (group B), and the modified cholangio-intestinal loop anastomosis (MCL)was performed in 23 cases (group C). Results At the end of 3 month followed-up after surgery, the clinically markedly effective rate in group C was 69.6%, significantly higher than 35.7% in group A or 43.3% in group B (P<0.05); at day three after operation, serum C-reactive protein level in group C was (12.9±2.4)mg/L, significantly lower than (14.6±2.9)mg/L in group A (P<0.05) or (16.7±2.8)mg/L in group B (P<0.05); the incidences of post-operational complications, such as bile leak, pancreatic leak, biliary bleeding, acute cholangitis and ascites in the three groups were 21.4%, 16.7% and 8.7%, not significantly different among them(P>0.05). Conclusion The application of modified cholangio-intestinal loop anastomosis in the treatment of children with CCC has a better overall clinical efficacy among others, which might be related to relatively easy complete operation under laparoscopy without dissociation of jejunum and little inflammatory reactions.

Key words: Congenital choledochal cyst, Laparoscopic operation, Hepaticoduodenostomy, Hepatojejunal Roux-en-Y anastomosis, Modified cholangio-intestinal loop anastomosis, Therapy