Liem Nguyen Thanh, Pham Hien Duy, Dung Le Anh, Son Tran Ngoc, Vu Hoan Manh
Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam.
J Laparoendosc Adv Surg Tech A. 2012 Jul-Aug;22(6):599-603. doi: 10.1089/lap.2012.0018. Epub 2012 Jun 12.
The aim of this study is to report early and intermediate outcomes of laparoscopic surgery for choledochal cysts with 400 cases.
The operation was performed using four ports. The cystic duct was identified and divided. The liver was suspended by two stay-sutures: one on the round ligament and the other on the distal cystic duct. The choledochal cyst was isolated and removed completely, and biliary-digestive continuity was reestablished by hepaticoduodenostomy (HD) or hepaticojejunostomy (HJ).
From January 2007 to June 2011, 400 patients were operated on. There were 305 girls and 95 boys. Ages ranged from 1 month to 16 years (mean, 47.5±2.1 months). Cystic excision and HD were performed in 238 patients and HJ in 162 patients. The mean operating time was 164.8±51 minutes for the HD group and 220±60 minutes for the HJ group. Conversion to open surgery was required in 2 patients. There were no perioperative deaths. Postoperative biliary leakage occurred in 8 patients (2%), resolving spontaneously in 7 and requiring a second operation in 1 patient. The mean postoperative hospital stay was 6.4±0.3 days for the HD group and 6.7±0.5 days for the HJ group. Follow-up between 5 months and 57 months postdischarge (mean, 24.2±2.7 months) was obtained in 342 patients (85.5%). Cholangitis occurred in 5 patients (1.5%) in the HD group and 1 patient (0.6%) in the HJ group. Gastritis due to bilious reflux was 3.8% in the HD group.
Laparoscopic repair is a safe and effective procedure for choledochal cyst. The rate of cholangitis and anastomotic stenosis is low.
本研究旨在报告400例胆总管囊肿腹腔镜手术的早期和中期结果。
采用四孔法进行手术。识别并切断胆囊管。用两根牵引缝线悬吊肝脏：一根缝在圆韧带上，另一根缝在胆囊管远端。分离并完全切除胆总管囊肿，通过肝十二指肠吻合术（HD）或肝空肠吻合术（HJ）重建胆肠连续性。
2007年1月至2011年6月，对400例患者进行了手术。其中女孩305例，男孩95例。年龄范围为1个月至16岁（平均47.5±2.1个月）。238例患者行囊肿切除及HD，162例患者行HJ。HD组平均手术时间为164.8±51分钟，HJ组为220±60分钟。2例患者需转为开腹手术。无围手术期死亡病例。8例患者（2%）术后发生胆漏，7例自行缓解，1例需二次手术。HD组术后平均住院时间为6.4±0.3天，HJ组为6.7±0.5天。342例患者（85.5%）获得出院后5个月至57个月的随访（平均24.2±2.7个月）。HD组5例患者（1.5%）发生胆管炎，HJ组1例患者（0.6%）发生胆管炎。HD组胆汁反流性胃炎发生率为3.8%。
腹腔镜修复胆总管囊肿是一种安全有效的手术方法。胆管炎和吻合口狭窄发生率低。
