Xiao Hui, Huang Rui, Chen Long, Diao Mei, Li Long
Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
J Surg Res. 2018 Dec;232:492-496. doi: 10.1016/j.jss.2018.07.002. Epub 2018 Jul 25.
A 30-40 cm Roux loop is widely accepted in Kasai portoenterostomy in infants with Ohi Type III biliary atresia (BA), regardless of patient's size, to avoid reflux cholangitis. However, the redundant length of the jejunal limb may lead to complications; hence, we compared the outcome of a shorter Roux loop with the standard loop length in Kasai portoenterostomy in infants with Ohi Type III BA.
There were 166 patients with Ohi Type III BA who underwent the Kasai procedure and were prospectively randomized into two groups: (1) the long Roux loop group (LRLG) contained 91 patients, where a standard 30-40 cm Roux loop was used regardless of the child's size and (2) the short Roux loop group (SRLG) included 75 patients in which the Roux loop length was based on the distance between hepatic hilum and umbilicus. The follow-up periods were 3 to 50 mo. Contrast-enhanced ultrasonography of the upper gastrointestinal tract was studied, and laboratory tests were included during the follow-up period.
The mean Roux loop length of SRLG was 17.42 ± 3.91 cm (13-20 cm); it was significantly shorter than that of the LRLG (32.87 ± 3.91 cm [30-40 cm], P = 0.00). There were no significant differences between the LRLG and SRLG in terms of age, body weight at time of the operation, length of operation, blood loss during the operation, and length of postoperative hospital stay (64.50 ± 20.41 d versus 68.34 ± 17.59 d, 4.3 ± 0.8 kg versus 4.1 ± 1.2 kg, 187.6 ± 35.7 min versus 172.3 ± 20.4 min, 21.71 ± 9.41 mL versus 25.32 ± 10.82 mL, 9.01 ± 3.97 d versus 8.16 ± 2.40 d; P = 0.63, 0.47, 0.09, 0.89, and 0.61, respectively). Six months after the operation, the clearance of jaundice rate in the LRLG was 45.1% (41/91), while the rate was 50.7% (38/75) in the SRLG; there was no statistically significant difference (P = 0.47). The incidence of cholangitis in the LRLG was 42.9% (39/91), which was similar to that of the SRLG (46.7%, 35/75) (P = 0.62). The incidence of overall complications (such as intestinal obstruction, gastrointestinal bleeding, bile leak, and anastomotic stenosis) in the SRLG was lower than that of the LRLG, but the difference did not reach statistical significance (4/91, 4.4% versus 5/75, 6.7%; P = 0.76). According to the Kaplan-Meier survival analysis and log rank test, the native liver survival rate in the LRLG and the SRLG also showed no significant difference (P = 0.964, log rank test). Grade I reflux was detected in three patients in the LRLG and two patients in the SRLG (P = 0.54). However, the reflux subsided 6 months later in all five patients.
A shorter Roux-loop length in Kasai portoenterostomy reconstruction had a similar efficacy as the conventional Roux-loop length.
在患有大日III型胆道闭锁（BA）的婴儿进行肝门空肠吻合术时，无论患儿体型如何，30 - 40厘米的Roux袢被广泛采用，以避免反流性胆管炎。然而，空肠袢的多余长度可能会导致并发症；因此，我们比较了较短Roux袢与标准袢长度在大日III型BA婴儿肝门空肠吻合术中的效果。
166例大日III型BA患者接受了肝门空肠吻合术，并被前瞻性随机分为两组：（1）长Roux袢组（LRLG）包含91例患者，无论患儿体型如何，均使用标准的30 - 40厘米Roux袢；（2）短Roux袢组（SRLG）包括75例患者，其中Roux袢长度基于肝门与脐之间的距离。随访期为3至50个月。研究了上消化道的对比增强超声检查，并在随访期间进行了实验室检查。
SRLG的平均Roux袢长度为17.42 ± 3.91厘米（13 - 20厘米）；明显短于LRLG（32.87 ± 3.91厘米[30 - 40厘米]，P = 0.00）。LRLG和SRLG在年龄、手术时体重、手术长度、手术期间失血以及术后住院时间方面无显著差异（64.50 ± 20.41天对68.34 ± 17.59天，4.3 ± 0.8千克对4.1 ± 1.2千克，187.6 ± 35.7分钟对172.3 ± 20.4分钟，21.71 ± 9.41毫升对25.32 ± 10.82毫升，9.01 ± 3.97天对8.16 ± 2.40天；P分别为0.63、0.47、0.09、0.89和0.61）。手术后6个月，LRLG的黄疸清除率为45.1%（41/91），而SRLG的黄疸清除率为50.7%（38/75）；无统计学显著差异（P = 0.47）。LRLG的胆管炎发生率为42.9%（39/91），与SRLG的发生率（46.7%，35/75）相似（P = 0.62）。SRLG的总体并发症（如肠梗阻、胃肠道出血、胆漏和吻合口狭窄）发生率低于LRLG，但差异未达到统计学显著性（4/91，4.4%对5/75，6.7%；P = 0.76）。根据Kaplan - Meier生存分析和对数秩检验，LRLG和SRLG的自体肝生存率也无显著差异（P = 0.964，对数秩检验）。LRLG中有3例患者和SRLG中有2例患者检测到I级反流（P = 0.54）。然而，所有5例患者在6个月后反流消失。
肝门空肠吻合术重建中较短的Roux袢长度与传统Roux袢长度具有相似的疗效。
