Alkhasov A B, Gurskaya A S, Bayazitov R R, Nakovkin O N, Sulavko M A, Karnuta I V, Ekimovskaya E V, Kyarimov I A, Akhmedova D M, Klepikova A A, Ratnikov S A, Fisenko A P
National Medical Research Center for Children's Health, Moscow, Russia.
Khirurgiia (Mosk). 2024(3):5-13. doi: 10.17116/hirurgia20240315.
To improve postoperative outcomes in newborns and infants with choledochal cysts and to determine the indications for surgery.
There were 13 children aged 0-3 months with choledochal cyst who underwent reconstructive surgery between 2019 and 2023. In all children, choledochal cyst was associated with cholestasis. Acholic stool was observed in almost half of the group (=7). All children underwent cyst resection and Roux-en-Y hepaticoenterostomy.
Symptoms of cholestasis regressed in all patients. Mean surgery time was 128±27 min. There were no complications. Enteral feeding was started after 1-2 postoperative days, abdominal drainage was removed after 6.2±1.6 days. Mean length of hospital-stay was 16±3.7 days. Adequate bile outflow is one of the main principles. For this purpose, anastomosis with intact tissues of hepatic duct should be as wide as possible. Roux-en-Y loop should be at least 40-60 cm to prevent postoperative cholangitis.
Drug-resistant cholestasis syndrome and complicated choledochal cysts (cyst rupture, bile peritonitis) are indications for surgical treatment in newborns and infants. When forming Roux-en-Y hepaticoenterostomy, surgeon should totally excise abnormal tissues of the biliary tract to prevent delayed malignant transformation.
改善胆总管囊肿患儿术后预后并确定手术指征。
2019年至2023年期间，13例年龄在0至3个月的胆总管囊肿患儿接受了重建手术。所有患儿均伴有胆汁淤积。几乎一半患儿（=7例）出现陶土样便。所有患儿均接受了囊肿切除及 Roux-en-Y 肝肠吻合术。
所有患者胆汁淤积症状均消退。平均手术时间为128±27分钟。无并发症发生。术后1至2天开始肠内喂养，术后6.2±1.6天拔除腹腔引流管。平均住院时间为16±3.7天。充足的胆汁流出是主要原则之一。为此，与肝管完整组织的吻合应尽可能宽。Roux-en-Y袢应至少40至60厘米以预防术后胆管炎。
耐药性胆汁淤积综合征及复杂胆总管囊肿（囊肿破裂、胆汁性腹膜炎）是新生儿和婴儿手术治疗的指征。在进行Roux-en-Y肝肠吻合术时，外科医生应彻底切除胆道异常组织以防止延迟性恶性转化。
