腹腔镜囊肿切除联合肝总管空肠Roux-en-Y吻合术治疗小儿胆总管囊肿临床效果评介*

doi:10.3969/j.issn.1672-5069.2025.06.036

摘要/Abstract

摘要： 目的总结腹腔镜囊肿切除术(LCCR)治疗小儿胆总管囊肿(CC)的疗效。方法 2019年1月～2024年1月我院收治的CC患儿26例,其中Todani Ia型16例(61.5%),Ib型1例(3.8%),Ic型1例(3.8%)和VI型8例(30.8%)。接受开放手术治疗14例,接受LCCR联合肝总管空肠Roux-en-Y吻合术治疗12例。术后,随访3个月。结果腔镜手术组手术时间、肠鸣音恢复时间、肛门首次排气时间和术后住院日分别为(67.2±11.6)min、(22.0±4.8)h、(42.8±7.0)h和(6.5±1.2)d,均显著短于开放手术组【分别为(85.4±13.5)min、(30.8±5.5)h、(56.5±7.4)h和(8.5±2.3)d,P<0.05】;在术后5 d,开放手术组外周血白细胞计数和血清CRP水平分别为(15.6±4.0)×10⁹/L和(26.8±2.9)mg/L,均显著高于腔镜手术组【分别为(12.8±3.7)×10⁹/L和(14.3±2.5)mg/L,P<0.05】;在术后3个月,经影像学检查,两组手术均获得成功,无囊肿复发病例;术后,腔镜手术组发生胆漏1例,胰漏1例,开放手术组发生胆漏1例,急性胆管炎1例,两组围手术期并发症发生率无统计学差异(P>0.05)。结论施行LCCR联合肝总管空肠Roux-en-Y吻合术治疗儿童CC临床疗效与开放手术大致相同,但可能创伤较小,显著缩短手术时间,有利于患儿术后康复。

关键词: 胆总管囊肿, 腹腔镜下囊肿切除术, 肝总管空肠Roux-en-Y吻合术, 治疗, 小儿

Abstract: Objective The purpose of this study was to summarize laparoscopic choledochal cyst resection in children. Methods The clinical materials in 26 children with choledochal cyst (CC) were retrieved and summarized between January 2019 and January 2024, and Todani classification showed type Ia in 16 cases (61.5%), type Ib in 1 case (3.8%), type Ic in 1 case (3.8%) and type VI in 8 cases (30.8%). Opencholedochal cyst resection (OCCR) were performed in 14 cases, and laparoscopic choledochal cyst resection (LCCR) and Roux-en-Y anastomosis of common hepatic duct and jejunum were underwent in 12 cases. All children were followed-up for three months. Results Operation time, recovery time of bowel sounds, first time of anal exhaust and hospital stay in LCCR group were(67.2±11.6)min, (22.0±4.8)h, (42.8±7.0)h and (6.5±1.2)d, all significantly shorter than [(85.4±13.5)min, (30.8±5.5)h, (56.5±7.4)h and (8.5±2.3)d, respectively, P<0.05] in OCCR group; by five days after operation, white blood cell count and serum C-reactive protein (CRP) level in open surgery group were (15.6±4.0)×10⁹/L and (26.8±2.9)mg/L, both much higher than [(12.8±3.7)×10⁹/L and (14.3±2.5)mg/L, respectively, P<0.05] in LCCR group; by three months after surgery, all operations succeeded in the two groups as validated by imaging, and no cysts recurred; post-operationally, bile leakage occurred in one case and pancreatic leakage in one case in LCCR group, and bile leakage occurred in one case and acute cholangitis in one case in OCCR group, no significant differences between the two groups(P>0.05). Conclusion The overall clinical efficacy of LCCR and Roux-en-Y anastomosis of common hepatic duct and jejunum in dealing with children with CC is satisfactory, with similar efficacy of OCCR, but damage less tissue wound, which might shorten operation time and improve recovery.

Key words: Choledochal cyst, Laparoscopic choledochal cyst resection, Roux-en-Y anastomosis of common hepatic duct and jejunum, Operation, Children

张莹楠, 张贝克, 王瑛. 腹腔镜囊肿切除联合肝总管空肠Roux-en-Y吻合术治疗小儿胆总管囊肿临床效果评介^*[J]. 实用肝脏病杂志, 2025, 28(6): 942-945.

Zhang Yingnan, Zhang Beike, Wang Ying. A safe and effective procedure for radical pediatric choledochal cyst excision: A single center experience[J]. Journal of Practical Hepatology, 2025, 28(6): 942-945.

参考文献

[1] Achatsachat P, Intragumheang C, Srisan N, et al. Surgical aspects of choledochal cyst in children and adults: an experience of 106 cases. Pediatr Surg Int, 2024, 40(1):183.
[2] Howell TC, Beckhorn CB, Antiel RM, et al. Contemporary trends in choledochal cystexcision: An analysis of the pediatric national surgical quality improvement program. World J Surg, 2024, 48(4):967-977.
[3] Cheng J, Yu Q, Fu J, et al. Non-stapled, total laparoscopic Roux-en-Y anastomosis: A safe and effective procedure for radical pediatric choledochal cyst excision. Surg Open Sci, 2024, 17:49-53.
[4] Noitumyae J, Amnuaypol J, Kiataramkul C, et al. Laparoscopic hepatic ductoplasty in pediatric choledochal cyst: What is the role, feasibility, and outcome?-systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A, 2024, 34(6):546-553.
[5] 侯文英, 李龙, 明安晓, 等. 经脐单一切口腹腔镜先天性胆总管囊肿肝管空肠Roux-en-Y吻合手术技巧. 中华小儿外科杂志, 2013, 34(7):497-500.
[6] Li B, Chen BW, Xia LS. The initial experience of laparoscopic management for type VI choledochal cyst in children. J Laparoendosc Adv Surg Tech A, 2024, 34(3):280-283.
[7] 何朝升, 苏毅, 黄桂珍, 等. 针式抓钳辅助单孔腹腔镜肝管空肠吻合治疗小儿胆总管囊肿的经验. 中华肝胆外科杂志, 2022, 28(9):673-677.
[8] Gu J, Cao J, Cao W, et al. Optimized reusable modular 3D-printed models of choledochal cyst to simulate laparoscopic and robotic bilioenteric anastomosis. Sci Rep, 2024, 14(1):8807.
[9] 韩啸, 郭万亮, 方林. 不同 Todani 分型小儿先天性胆总管囊肿CT 表现. 实用肝脏病杂志, 2021, 24(2):284-287.
[10] 杨甲梅. 实用肝胆外科学. 上海: 上海人民出版社, 2009, 113-116.
[11] Lee JS, Yoon YC. Laparoscopic treatment of choledochal cyst using barbed sutures. J Laparoendosc Adv Surg Tech A, 2017, 27(1):58-62.
[12] 王新宁, 李索林, 刘雪来, 等. 腹腔镜下LCCR术不同胆道重建方法的研究. 临床小儿外科杂志, 2019, 18(7):559-562.
[13] 易军, 孙斌, 李涛, 等. 改良胆肠袢式吻合术治疗小儿胆道扩张症. 中华小儿外科杂志, 2010, 4(3):272-275.
[14] 向东洲, 王康太, 卢宗耀, 等. 不同胆道重建方法治疗先天性胆管扩张症的疗效对比研究. 中华普通外科学文献(电子版), 2018, 12(4):255-259.
[15] Yan J, Lyu C, Zhang D, et al. Management of complicated choledochal cyst in children: ultrasound-guided percutaneous external drainage and subsequent definitive operation. BMC Pediatr, 2023, 23(1):266.
[16] Guan X, Li J, Wang Z, et al. Timing of operationin children with a prenatal diagnosis of choledochal cyst: A single-center retrospective study. J Hepatobiliary Pancreat Sci, 2022, 29(12):1308-1315.
[17] Chen J, Jiang B, Yi J, et al. Modified biliary-enteric anastomosis for congenital choledochal cyst: clinical and prognostic analysis of 91 cases. Pediatr Surg Int, 2017, 33(6):721-726.
[18] Yeung F, Fung ACH, Chung PHY, et al. Short-term and long-term outcomes after Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy following laparoscopic excision of choledochal cyst in children. Surg Endosc, 2020, 34(5):2172-2177.
[19] 蔡多特, 高志刚, 章跃滨, 等. 腹腔镜胆总管囊肿根治术后中远期并发症分析及治疗经验总结. 中华小儿外科杂志, 2019, 40(5):440-446.
[20] Chi SQ, Cao GQ, Li S, et al. Outcomes in robotic versus laparoscopic-assisted choledochal cyst excision and hepaticojejunostomy in children. Surg Endosc, 2021, 35(9):5009-5014.
[21] Xie X, Li K, Xiang B. Total versus conventional robotic-assisted cyst excisions and hepaticojejunostomies in children with choledochal cysts: a case-control study. J Robot Surg, 2023, 17(3):869-876.

腹腔镜囊肿切除联合肝总管空肠Roux-en-Y吻合术治疗小儿胆总管囊肿临床效果评介^*

A safe and effective procedure for radical pediatric choledochal cyst excision: A single center experience

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	姚羽, 宁波. 肝硬化门静脉血栓形成机制、自发性再通和抗凝治疗研究进展^*[J]. 实用肝脏病杂志, 2025, 28(6): 801-804.
[2]	李思思, 姜艳贞, 付兆媛. 中西医结合治疗肝纤维化研究进展与思考^*[J]. 实用肝脏病杂志, 2025, 28(6): 805-808.
[3]	华琪, 刘琼, 陈琦. 艾米替诺福韦治疗经恩替卡韦治疗的低病毒血症的慢性乙型肝炎患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 818-821.
[4]	蒋婵娟, 邵靖渊, 徐林. 艾尔巴韦/格拉瑞韦治疗慢性肾病合并慢性丙型肝炎患者疗效和安全性研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 822-825.
[5]	王超杰, 谢群, 姜海, 周宝勤, 杨亮. 3D方案治疗初始治疗的基因1b型慢性丙型肝炎患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 826-829.
[6]	李卉, 陶娅, 胥勋梅, 王金帆. 利拉鲁肽治疗NAFLD合并T2DM患者疗效及其对外周血单个核细胞NLRP3、Caspase-1和ASC水平的影响^*[J]. 实用肝脏病杂志, 2025, 28(6): 830-833.
[7]	郑慧慧, 王玉蓉, 徐婷. 血脂康联合阿托伐他汀治疗非酒精性脂肪性肝病合并高脂血症患者效果研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 834-837.
[8]	王美玲, 李洁, 刘娟, 孙婷婷. 司美格鲁肽联合非诺贝特治疗2型糖尿病合并非酒精性脂肪性肝病患者疗效初步研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 838-841.
[9]	高海娜, 梁盼, 高琳辉, 朱立影, 宋媛, 李印肖, 刘阳. 艾塞那肽联合二甲双胍治疗非酒精性脂肪性肝病合并2型糖尿病患者疗效初步研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 842-845.
[10]	陈晓玲, 张盼盼, 付玉芳, 王静. 司美格鲁肽联合化痰祛瘀通络方治疗NAFLD合并T2DM患者临床疗效初步研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 846-849.
[11]	田巍巍, 孙佳琦, 陈恳, 黄亚彬, 李锋, 冯海娟. 标准免疫抑制疗法联合甘草酸二铵治疗自身免疫性肝炎患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 854-857.
[12]	黄晓黎, 沈杰. 恩替卡韦联合红外肝病治疗仪治疗乙型肝炎肝硬化患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 878-881.
[13]	杨兰, 许诗杰, 包华鑫. 肝细胞癌患者TACE术后血清FGFR1、VEGFA和IRX5水平变化及其与疗效的关系研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 890-893.
[14]	李建林, 李娅, 郑秋然, 王燕. ¹²⁵I放射性粒子植入联合TACE治疗原发性肝癌患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 894-897.
[15]	田潭平, 杨定华, 宋新, 周旅, 周国超, 付华, 蔡融民, 彭鹏. TACE联合免疫和靶向综合治疗中晚期原发性肝癌患者临床效果研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 898-901.