Miyano Go, Koyama Mariko, Miyake Hiromu, Kaneshiro Masakatsu, Morita Keiichi, Nakajima Hideaki, Yamoto Masaya, Nouso Hiroshi, Fukumoto Koji, Urushihara Naoto
Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
Asian J Endosc Surg. 2017 Aug;10(3):295-300. doi: 10.1111/ases.12358. Epub 2017 Jan 30.
The aim of this study was to compare laparoscopic hepaticojejunostomy (LHJ) and open hepaticojejunostomy (OHJ) for choledochal cyst associated with hilar hepatic duct stenosis (HHDS).
Data collection was prospective for LHJ cases from 2009 and retrospective for OHJ cases from 2003 to 2008. Data were compared with respect to HHDS. HHDS was incised longitudinally as required during hilar hepatic ductoplasty.
Fifty-eight subjects were studied (LHJ: n = 27, 4 boys, 23 girls; OHJ: n = 31; 6 boys, 25 girls). HHDS was present in 10 LHJ cases and 10 OHJ cases. Todani classification of choledochal cyst in LHJ patients was type 1A (n = 16) and type 4A (n = 11), and in OHJ patients, it was type 1A (n = 19) and type 4A (n = 12). There were significant differences between LHJ and OHJ with regard to mean operative time (386 vs 341 min), mean blood loss (5.9 vs 18.4 mL), recommencement of enteral feeding (3.9 vs 6.4 days), and hospital stay (11.7 vs 15.5 days) (all P < 0.05). Hepatic ductoplasty was performed in 23 LHJ patients and in 21 OHJ patients. There were no intraoperative complications and no conversions to OHJ. There were no significant differences between LHJ and OHJ, regardless of the presence of HHDS, for postoperative complications, which included minor bile leakage, anastomotic stricture, and intestinal obstruction.
LHJ is as effective as OHJ for the treatment of choledochal cysts irrespective of the presence of HHDS and the need for hepatic ductoplasty.
本研究旨在比较腹腔镜肝管空肠吻合术（LHJ）与开放肝管空肠吻合术（OHJ）治疗合并肝门部肝管狭窄（HHDS）的胆总管囊肿的效果。
2009年LHJ病例的数据收集为前瞻性，2003年至2008年OHJ病例的数据收集为回顾性。就HHDS对数据进行比较。在肝门部肝管整形术中，根据需要纵向切开HHDS。
共研究了58例患者（LHJ组：n = 27，4例男孩，23例女孩；OHJ组：n = 31，6例男孩，25例女孩）。10例LHJ患者和10例OHJ患者存在HHDS。LHJ组患者胆总管囊肿的Todani分类为1A型（n = 16）和4A型（n = 11），OHJ组患者为1A型（n = 19）和4A型（n = 12）。LHJ组与OHJ组在平均手术时间（386对341分钟）、平均失血量（5.9对18.4毫升）、肠内营养恢复时间（3.9对6.4天）和住院时间（11.7对15.5天）方面存在显著差异（均P < 0.05）。23例LHJ患者和21例OHJ患者进行了肝管整形术。无术中并发症，无转为OHJ手术的情况。无论是否存在HHDS，LHJ组与OHJ组术后并发症（包括轻微胆漏、吻合口狭窄和肠梗阻）无显著差异。
无论是否存在HHDS以及是否需要进行肝管整形术，LHJ治疗胆总管囊肿的效果与OHJ相同。
