Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Nankai District, No. 122, San Wei Road, Tianjin, 300100, China.
Department of Gastrointestinal Surgery, Tianjin Nankai Hospital, Tianjin, China.
Surg Endosc. 2021 Mar;35(3):1093-1100. doi: 10.1007/s00464-020-07473-z. Epub 2020 Feb 24.
Choledochal cyst (CC)is a rare disease entity, more commonly occurring in Asian populations. In case of no contraindication, CC is resected to avoid future malignancies and future complications.
To determine the optimal technique for treatment of patients with type I choledochal cyst by comparisons of indicators, including the duration of surgery, loss of blood, rates of complication, duration of hospitalization, and outcomes of long-term follow-up.
From January 2009 to September 2017, a combination of laparoscopy and choledochoscopy surgery was implemented for type I choledochal cyst in adult. Patients' demographics data and treatment outcomes were collected prospectively during the follow-up.
Fifty-eight patients with type I choledochal cyst were managed using this strategy. The combination of laparoscopic and intraoperative choledochoscopy was successfully performed in all patients without conversion or morbidity. When compared with a historical cohort of 71 patients who underwent a surgery for CC, this group of patients had significantly shorter duration of hospitalization (9.0 ± 6.5 days vs. 13.0 ± 8.0 days, P < 0.05). We also observed a lower blood loss (128.8 ± 60.2 mL vs. 178.1 ± 58.2 mL, P < 0.05), although the duration of the surgery (320.0 ± 50.0 min vs. 190.0 ± 24.5 min, P < 0.05) was longer. However, no significant difference was found in the rate of postoperative bleeding complication (3.45% vs. 4.23%, P = 0.82) and bile leakage complication (6.90% vs. 4.23%, P = 0.51). The two groups had similar rates of anastomotic stenosis (0.96% vs. 0.61%%, P = 0.47), jaundice (0.58% vs. 0.61%, P = 0.95), cholangitis (0.38% vs. 0.30%, P = 0.81), and reoperation (0.38% vs. 0.15%, P = 0.43).
The type I choledochal cyst in adult can be effectively managed by laparoscopic surgery combined with inoperative choledochoscopy, which is feasible and minimally invasive. With the development of laparoscopic techniques and instruments, laparoscopic surgery may become the first-choice treatment for type I choledochal cyst treatment.
胆总管囊肿（CC）是一种罕见的疾病实体，更常见于亚洲人群。在没有禁忌症的情况下，应切除 CC 以避免未来的恶性肿瘤和未来的并发症。
通过比较手术时间、失血量、并发症发生率、住院时间和长期随访结果等指标，确定治疗 I 型胆总管囊肿患者的最佳技术。
从 2009 年 1 月至 2017 年 9 月，对成人 I 型胆总管囊肿采用腹腔镜联合胆管镜手术治疗。在随访期间，前瞻性收集患者的人口统计学数据和治疗结果。
58 例 I 型胆总管囊肿患者采用该策略进行治疗。所有患者均成功完成腹腔镜联合术中胆管镜手术，无中转或并发症发生。与 71 例接受 CC 手术治疗的历史队列相比，该组患者的住院时间明显缩短（9.0±6.5 天 vs. 13.0±8.0 天，P<0.05）。我们还观察到失血量减少（128.8±60.2 毫升 vs. 178.1±58.2 毫升，P<0.05），尽管手术时间较长（320.0±50.0 分钟 vs. 190.0±24.5 分钟，P<0.05）。然而，术后出血并发症发生率（3.45% vs. 4.23%，P=0.82）和胆漏并发症发生率（6.90% vs. 4.23%，P=0.51）无显著差异。两组吻合口狭窄发生率（0.96% vs. 0.61%，P=0.47）、黄疸发生率（0.58% vs. 0.61%，P=0.95）、胆管炎发生率（0.38% vs. 0.30%，P=0.81）和再次手术率（0.38% vs. 0.15%，P=0.43）相似。
腹腔镜手术联合术中胆管镜检查可有效治疗成人 I 型胆总管囊肿，具有可行性和微创性。随着腹腔镜技术和器械的发展，腹腔镜手术可能成为治疗 I 型胆总管囊肿的首选方法。
