腹腔镜联合术中胆道镜治疗胆总管囊肿。

Laparoscopy combined with intraoperative choledochoscopy for the treatment of cheoledochal cysts.

作者信息

Wang Wenjing, Yang Jixin, Li Dandan, Song Yang, Xiong Xiaofeng, Zhu Tianqi, Wu Xiaojuan, He Ying, Liu Shuaibin, Feng Jiexiong

机构信息

Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.

出版信息

Surg Endosc. 2025 Sep 4. doi: 10.1007/s00464-025-12162-w.

DOI:10.1007/s00464-025-12162-w

PMID:40908333

Abstract

OBJECTIVE

To evaluate the efficacy of laparoscopy combined with intraoperative choledochoscopy in treating choledochal cysts and preventing postoperative complications.

PATIENTS AND METHODS

This single-center retrospective study included 208 patients with Todani type I choledochal cysts treated laparoscopically from January 2016 to January 2023. Patients undergoing open surgery were excluded. Of these, 138 cases were treated with 6 Fr catheter irrigation (Group A), while 70 cases underwent intraoperative choledochoscopy for thorough irrigation and stone extraction (Group B). All patients were followed up for at least 18 months. Data collected included age at operation, gender, cyst diameter, preoperative manifestations, and postoperative outcomes. Statistical analysis was performed using Student's t-test for continuous data and Fisher's exact test for categorical data, with P < 0.05 indicating significance.

RESULTS

Clinical data of 187 cases were analyzed after excluding 21 lost to follow-up. No significant differences were found between Group A (n = 124) and Group B (n = 63) in age at operation (35.4 ± 17.2 months vs. 38.9 ± 19.6 months, P = 0.875), gender distribution (male:female ratio 34:90 vs. 13:50, P = 0.891), cyst diameter (25.6 ± 17.8 mm vs. 23.1 ± 17.5 mm, P = 0.758), or preoperative stone presence (54/124 vs. 25/63, P = 0.918). However, Group B had significantly lower incidence of residual/recurrent stones (1/63 vs. 14/124, P = 0.021) and postoperative pancreatitis (1/63 vs. 7/124, P = 0.044). At 6-month follow-up, intrahepatic bile duct dilation was significantly lower in Group B (0/63 vs. 6/124, P = 0.038), and hospital stay was shorter (9.1 ± 2.2 days vs. 10.7 ± 2.1 days, P = 0.003) without significant increase in total medical expenses (39059.6 ± 4115.3 RMB vs. 38422.8 ± 3341.6 RMB, P = 0.291).

CONCLUSIONS

Laparoscopy combined with intraoperative choledochoscopy is feasible and effective in clearing biliary stones, preventing postoperative complications such as pancreatitis and bile duct dilation, and identifying hepatic duct stenosis in choledochal cyst treatment.

摘要

目的

评估腹腔镜联合术中胆道镜治疗胆总管囊肿及预防术后并发症的疗效。

患者与方法

本单中心回顾性研究纳入了208例2016年1月至2023年1月接受腹腔镜治疗的托达尼I型胆总管囊肿患者。排除接受开放手术的患者。其中，138例采用6Fr导管冲洗治疗（A组），70例接受术中胆道镜彻底冲洗和取石（B组）。所有患者均随访至少18个月。收集的数据包括手术年龄、性别、囊肿直径、术前表现和术后结果。连续数据采用Student's t检验进行统计分析，分类数据采用Fisher精确检验，P < 0.05表示有统计学意义。

结果

排除21例失访患者后，分析了187例患者的临床资料。A组（n = 124）和B组（n = 63）在手术年龄（35.4 ± 17.2个月 vs. 38.9 ± 19.6个月，P = 0.875）、性别分布（男:女比例34:90 vs. 13:50，P = 0.891）、囊肿直径（25.6 ± 17.8 mm vs. 23.1 ± 17.5 mm，P = 0.758）或术前结石存在情况（54/124 vs. 25/63，P = 0.918）方面无显著差异。然而，B组残余/复发性结石的发生率（1/63 vs. 14/124，P = 0.021）和术后胰腺炎的发生率（1/63 vs. 7/124，P = 0.044）显著较低。在6个月随访时，B组肝内胆管扩张情况显著较轻（0/63 vs. 6/124，P = 0.038），住院时间较短（9.1 ± 2.2天 vs. 10.7 ± 2.1天，P = 0.003），且总医疗费用无显著增加（39059.6 ± 4115.3元 vs. 38422.8 ± 3341.6元，P = 0.291）。