Wang Bin, Feng Qi, Ye Xiaoshuo, Zeng Shuaidan
Department of Hepatobiliary Surgery, Shenzhen Children's Hospital , Shenzhen, China .
J Laparoendosc Adv Surg Tech A. 2014 May;24(5):350-3. doi: 10.1089/lap.2013.0138. Epub 2014 Jan 21.
The laparoscopic Kasai operation has been under debate for a long time. In this study, we described our experience in laparoscopic portoenterostomy for biliary atresia
The operative experience in 25 cases of laparoscopic portoenterostomy for biliary atresia since January 2011 was reviewed. For the procedure, operative cholangiography was first performed for diagnosis. Laparoscopic Kasai portoenterostomy was performed as in the open manner. Electrocoagulation hemostasis was avoided at the porta, where bleeding was controlled with direct compression only. The Roux loop was fashioned outside of the abdominal cavity through the umbilical incision, and portoenterostomy was performed with absorbable sutures.
All cases underwent the operation successfully without conversion to open surgery. The average time of operation was 180-285 minutes (mean, 208 minutes), and the blood loss was 15-30 mL. Twenty-two (88%) patients had bile drainage postoperatively as indicated by their stool color. Jaundice was alleviated in 21 (84%) patients, with total bilirubin decreased by a third. Follow-up extended from 3 months to 2 years after the operation. Jaundice had completely subsided in 14 (56%) cases, with a normal level of bilirubin. Seven patients had an initial decrease in bilirubin, but jaundice returned because of cholangitis. Two patients died because their parents refused liver transplantation. Two cases underwent successful liver transplants.
Laparoscopic portoenterostomy for biliary atresia is safe and feasible. It has the advantage of clearer vision, precise operation, and less operative trauma. In our experience, the outcome of this surgery is as good as open surgery if the surgeons are well experienced.
腹腔镜下Kasai手术长期以来一直存在争议。在本研究中，我们描述了我们在腹腔镜肝门空肠吻合术治疗胆道闭锁方面的经验。
回顾了自2011年1月以来25例腹腔镜肝门空肠吻合术治疗胆道闭锁的手术经验。对于该手术，首先进行术中胆管造影以明确诊断。腹腔镜Kasai肝门空肠吻合术的操作方式与开放手术相同。肝门处避免使用电凝止血，仅通过直接压迫控制出血。经脐部切口在腹腔外制作Roux袢，并用可吸收缝线进行肝门空肠吻合。
所有病例均成功完成手术，未转为开放手术。平均手术时间为180 - 285分钟（平均208分钟），失血量为15 - 30毫升。22例（88%）患者术后粪便颜色提示有胆汁引流。21例（84%）患者黄疸减轻，总胆红素下降三分之一。术后随访时间为3个月至2年。14例（56%）患者黄疸完全消退，胆红素水平正常。7例患者最初胆红素下降，但因胆管炎黄疸复发。2例患者因家长拒绝肝移植死亡。2例患者成功接受肝移植。
腹腔镜肝门空肠吻合术治疗胆道闭锁安全可行。具有视野更清晰、操作精确及手术创伤更小的优点。根据我们的经验，如果外科医生经验丰富，该手术的效果与开放手术一样好。
