Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Batallón San Patricio #112, San Pedro Garza García, Monterrey, Nuevo León, Mexico.
Tecnológico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León, Mexico.
Pediatr Surg Int. 2021 Oct;37(10):1313-1322. doi: 10.1007/s00383-021-04940-z. Epub 2021 Jun 11.
Choledochal cysts are a rare pediatric biliary pathology. Excision of the extrahepatic cyst and restoration of biliary-enteric continuity through either hepaticoduodenostomy (HD) or Roux-en-Y hepaticojejunostomy (HJ) is the mainstay treatment. This study aims to determine if either method provides an advantage. Following PRISMA guidelines, a systematic review was conducted, identifying studies comparing hepaticojejunostomy to hepaticoduodenostomy in patients with choledochal cysts. Data were analyzed using Review Manager 5.3. Nine studies were included, operative time was shorter - 97.50 [- 172.31, - 22.69] p = 0.01 and bleeding reduced - 48.98 [- 88.25, - 9.71] p = 0.01 in HD. HD was associated with shorter length of stay 2.18 [- 3.87, - 0.50] p = 0.01 and similar cholangitis and reintervention rates. Time to a normal diet was similar between groups. Biliary reflux was seen more frequently in HD 19.14 [2.60, 140.63] p = 0.004. Complications such as leak and cholangitis were similar between groups. HD represents a viable alternative to HJ with various advantages such as shorter operative time, decreased bleeding and shorter length of hospital stay. Bile reflux remains a major limitation.Level of evidence IV.
胆总管囊肿是一种罕见的小儿胆系病理学疾病。切除肝外胆管囊肿并通过肝肠吻合术（HD）或 Roux-en-Y 肝肠吻合术（HJ）恢复胆肠连续性是主要的治疗方法。本研究旨在确定这两种方法是否具有优势。根据 PRISMA 指南，进行了系统评价，确定了比较胆管囊肿患者肝肠吻合术与肝肠吻合术的研究。使用 Review Manager 5.3 分析数据。共纳入 9 项研究，HD 的手术时间更短 [97.50（-172.31，-22.69），p=0.01]，出血量更少 [-48.98（-88.25，-9.71），p=0.01]。HD 与较短的住院时间相关 [2.18（-3.87，-0.50），p=0.01]，且胆系感染和再干预率相似。两组恢复正常饮食的时间相似。HD 中更频繁地出现胆汁反流 [19.14（2.60，140.63），p=0.004]。HD 和 HJ 的并发症如漏和胆系感染相似。HD 作为 HJ 的一种可行替代方法，具有多种优势，如手术时间更短、出血减少和住院时间更短。胆汁反流仍然是一个主要的局限性。证据等级为 IV 级。
