Cazares Joel, Koga Hiroyuki, Murakami Hiroshi, Nakamura Hiroki, Lane Geoffrey, Yamataka Atsuyuki
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Pediatr Surg Int. 2017 Dec;33(12):1341-1354. doi: 10.1007/s00383-017-4171-7. Epub 2017 Oct 11.
The aim of this report was to present the laparoscopic portoenterostomy (LapPE) procedure developed by the Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine (JLapPE). We also attempted to obtain an understanding of the current status of laparoscopic portoenterostomy in the world as reported in the English literature to compare with our experience.
There were 22 BA patients who had JLapPE between 2009 and 2016. BA classification was type III (n = 19) and type II (n = 3). There was 1 case of syndromic BA and 1 case was positive for cytomegalovirus. A systematic search in PubMed of all BA patients treated by LapPE in the English literature was conducted. Jaundice clearance (JC) and survival with the native liver (SNL) were compared.
Mean age at JLapPE was 67.1 days (range 29-119). Mean postoperative follow-up was 4.6 years (1.3-8.3). Mean operative time was 514 min (240-662) and mean blood loss was 13.4 g (3-21). Postoperative JC (Total bilirubin ≤ 1.5 mg/dL) was 77.3% (17/22) at 3 months and 90.9% (20/22) at 6 months. SNL at 6 months of age was 90.9% (20/22); at 1 year of age was 77.3% (17/22), at 2 years of age was 73.7% (14/19); and at 3 years of age was 81.3% (13/16).
Despite recent reports that outcome of LapPE for BA may be unfavorable compared with the conventional open portoenterostomy, our results would suggest that JLapPE can be performed successfully, because it is performed exactingly according to a standard protocol. JLapPE will continue to be our procedure of choice for treating BA.
本报告旨在介绍由顺天堂大学医学院小儿普通与泌尿生殖外科开发的腹腔镜肝门空肠吻合术（JLapPE）。我们还试图通过英文文献了解世界范围内腹腔镜肝门空肠吻合术的现状，以便与我们的经验进行比较。
2009年至2016年间有22例接受JLapPE的胆管闭锁患者。胆管闭锁分类为III型（n = 19）和II型（n = 3）。有1例综合征性胆管闭锁，1例巨细胞病毒检测呈阳性。我们在PubMed中对英文文献中所有接受腹腔镜肝门空肠吻合术治疗的胆管闭锁患者进行了系统检索。比较了黄疸清除率（JC）和自体肝生存率（SNL）。
接受JLapPE时的平均年龄为67.1天（范围29 - 119天）。术后平均随访时间为4.6年（1.3 - 8.3年）。平均手术时间为514分钟（240 - 662分钟），平均失血量为13.4克（3 - 21克）。术后3个月时黄疸清除率（总胆红素≤1.5mg/dL）为77.3%（17/22），6个月时为90.9%（20/22）。6个月龄时自体肝生存率为90.9%（20/22）；1岁时为77.3%（17/22），2岁时为73.7%（14/19）；3岁时为81.3%（13/16）。
尽管最近有报道称，与传统的开放肝门空肠吻合术相比，腹腔镜肝门空肠吻合术治疗胆管闭锁的效果可能不佳，但我们的结果表明，JLapPE可以成功实施，因为它是严格按照标准方案进行的。JLapPE将继续是我们治疗胆管闭锁的首选术式。
