Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Jiangsu, China.
Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Jiangsu, China.
J Surg Res. 2019 Jan;233:368-375. doi: 10.1016/j.jss.2018.08.013. Epub 2018 Sep 10.
Laparoscopic Kasai portoenterostomy (LKPE) is generally regarded to have a poorer outcome for surgical treatment of uncorrectable biliary atresia. We herein described our initial experience of some modifications to make LKPE easier in the treatment of type III biliary atresia (BA).
During the period July 2012-October 2016, a total of 25 infants with type III BA were treated with a modified LKPE technique. A percutaneous suture was introduced just below the xiphoid process to snare the round ligament and retract the liver; other percutaneous stay sutures were then introduced to the fundus and neck of the gallbladder to elevate the liver and expose the porta hepatis. In 15 cases, part of the hepatic lobus quadratus was removed laparoscopically to expose the porta hepatis. The two elastic rubber bands were put around the portal vein and hepatic artery, and the porta hepatis was exposed by stretching the two rubber bands laterally to facilitate laparoscopic portoenterostomy.
Patients were divided into two groups according to their ages at operation: group I: age between 30 and 75 days (n = 18), and group II: age between 76 and 85 days (n = 8). There were no operative deaths, but two patients died of repeated cholangitis and liver failure. Blood loss during operation was minimal and no blood transfusions were required. Operating times varied from 210 to 270 min (mean 232.4 ± 19.0 min). Among the two groups, there were no differences in blood loss (P > 0.05), but there were differences in operating time (P < 0.05). All patients survived the surgery without any intraoperative complications, and the median follow-up time was 25.3 months. Total bilirubin dropped to normal in 18 patients with an additional 5 patients showing a significant overall drop after surgery.
With the original concepts of Kasai portoenterostomy, perfect laparoscopic skills and some key modifications to expose the porta hepatis, our LKPE can be performed safely and successfully with improved outcome for infants with type III BA.
腹腔镜 Kasai 门腔分流术（LKPE）通常被认为在治疗不可矫正的胆道闭锁方面手术效果较差。本文介绍了我们在治疗 III 型胆道闭锁（BA）时对该术式进行一些改良以使其更容易操作的初步经验。
2012 年 7 月至 2016 年 10 月，共有 25 例 III 型 BA 婴儿采用改良 LKPE 技术进行治疗。在剑突下引入一根经皮缝线，以套扎圆韧带并牵拉肝脏；然后引入其他经皮缝线至胆囊底部和颈部，以提起肝脏并显露肝门。在 15 例病例中，通过腹腔镜切除部分肝方叶以显露肝门。将两条弹性橡胶带环绕门静脉和肝动脉，然后向两侧拉伸两条橡胶带，以显露肝门，便于进行腹腔镜门腔吻合术。
根据手术时的年龄将患者分为两组：I 组：3075 天（n=18），II 组：7685 天（n=8）。无手术死亡病例，但有 2 例患儿因反复胆管炎和肝功能衰竭死亡。术中出血量极少，无需输血。手术时间为 210~270min（平均 232.4±19.0min）。两组患儿的术中出血量差异无统计学意义（P>0.05），但手术时间差异有统计学意义（P<0.05）。所有患儿均顺利完成手术，无术中并发症，中位随访时间为 25.3 个月。18 例患儿的总胆红素降至正常，5 例患儿术后总胆红素总体显著下降。
在保留 Kasai 门腔吻合术的原始理念的基础上，运用完美的腹腔镜技术和一些关键的显露肝门的改良措施，我们的 LKPE 可安全、成功地应用于 III 型 BA 婴儿，改善了手术效果。
