Matsumoto Mariko, Urushihara Naoto, Fukumoto Koji, Yamoto Masaya, Miyake Hiromu, Nakajima Hideaki
Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan.
Surg Today. 2016 Dec;46(12):1410-1414. doi: 10.1007/s00595-016-1319-3. Epub 2016 Mar 2.
The aim of this study was to validate our laparoscopic management strategy for asymptomatic and symptomatic patients with prenatally diagnosed choledochal cysts (CCs).
Thirteen prenatally diagnosed CC patients from 1997 to 2015 were included. Seven patients (1997-2008) underwent open surgery (OS group), and 6 (2009-2015) underwent laparoscopic surgery (LS group). In the asymptomatic patients, LS was performed when the patients weighed over 5 kg. When the patient had clinical manifestations, early LS was performed irrespective of body weight. A retrospective comparison was conducted between the LS and OS groups in terms of the operative time, blood loss, postoperative fasting period, hospital stay, and intra- and postoperative complications.
There was no difference between the demographics of both groups. The operative time was significantly longer (380 vs. 288 min) and blood loss was significantly lower (4 vs. 30 mL) in the LS group. Additionally, the postoperative fasting period (3 vs. 6 days) and hospital stay (11 vs. 20 days) were significantly shorter in the LS group. Intraoperative events and early postoperative complications were not encountered in either group. Small bowel obstruction requiring surgery occurred in two patients, 10 and 13 years after OS, respectively.
LS is as safe and feasible as OS in small children with prenatally diagnosed CC, although sufficient pediatric laparoscopic expertise is mandatory.
本研究旨在验证我们对产前诊断为胆总管囊肿（CCs）的无症状和有症状患者的腹腔镜治疗策略。
纳入1997年至2015年期间13例产前诊断为CCs的患者。7例患者（1997 - 2008年）接受了开放手术（OS组），6例（2009 - 2015年）接受了腹腔镜手术（LS组）。对于无症状患者，当体重超过5 kg时进行LS。当患者有临床表现时，无论体重如何均尽早进行LS。对LS组和OS组在手术时间、失血量、术后禁食期、住院时间以及术中及术后并发症方面进行回顾性比较。
两组的人口统计学特征无差异。LS组的手术时间明显更长（380对288分钟），但失血量明显更低（4对30毫升）。此外，LS组的术后禁食期（3对6天）和住院时间（11对20天）明显更短。两组均未发生术中事件和早期术后并发症。OS术后10年和13年分别有2例患者发生需要手术治疗的小肠梗阻。
对于产前诊断为CCs的小儿患者，LS与OS一样安全可行，不过必须具备足够的小儿腹腔镜专业技能。
