摘要
目的探讨手术方式、年龄及囊肿扩张形状与胆总管囊肿手术疗效的关系。方法先天性胆总管囊肿患儿83例（男23例，女60例，平均年龄3．8岁），采用囊肿切除、肝管空肠Roux-Y吻合术治疗，其中腹腔镜下手术59例，开腹手术24例。对83例患儿手术前后血生化指标进行分析，包括总胆红素（TBIL）、直接胆红素（DBIL）、AST、ALT、GGT和ALP。根据手术年龄将患儿分为三组：〈1岁组，1～3岁组和〉3岁组。根据囊肿扩张形状分为囊形扩张组和梭形扩张组。分析手术方式、手术年龄及囊肿扩张形状与手术前后血生化变化的关系，探讨手术方式、手术年龄及囊肿扩张形状与手术疗效的关系。结果所有患儿术后血TBIL、DBIL和ALP水平较术前显著降低；腹腔镜手术与开放手术比较，术后各生化指标降低程度无显著差别。手术年龄越小，术前血胆红素水平越高，肝功能指标越高。3岁以内手术者术后TBIL和DBIL降低程度显著高于手术年龄〉3岁者。、囊形扩张组和梭形扩张组比较，术后肝功能降低程度无显著差别；囊形扩张组术后TBIL、DBIL和ALP较术前显著降低。结论腹腔镜胆总管囊肿根治术手术疗效与开放手术无差别。早期发病的胆总管囊肿患儿（3岁以内）肝损伤较严重，应及早手术，术后效果明显。囊肿扩张形状不影响胆总管囊肿根治术的手术疗效，但囊形扩张者手术效果更明显。
Objective To investigate the relationship between surgical procedure, operative age and shapes of cyst and prognosis of Choledochal Cysts （CC）. Methods 83 children （23 boys and 60 girls, mean age 3.8 years） with CC underwent the total cyst excision with Roux-Y hepatoenterostomy in our hospital. Of all 83 children, 59 children were treated by laparoscopy and 24 were treated by laparotomy. Based on the operative age, all of patients were grouped into three subgroups ： 〈 1 year old, 1 ~ 3 years old and 〉 3 years old. According to the shape of cyst, all of patients were grouped into two subgroups： cystiform and fusiform groups. In the present study, the pre-and post-operative blood biochemical indexes, age at operation and the dilatation of the common bile duct were studied. Results The levels of the serum TBIL, DBIL and ALP post- operatively were significantly decreased than those preoperatively. The age at operation was associated with the pre-operative levels of the bilirubin and the liver function indexes. The postoperative levels of the TBIL and DBIL of the children who were less than three years old were significantly lower than those of the children who were more than three years old. There was no relationship between the shapes of the cysts and the surgical out- come. Conclusions The outcome of laparoscopic total cyst excision with Roux-Y hepatoenterostomy for CC was no different with the open surgery. The liver damage of the children who were less than three years old was serious, and the surgical outcome is satisfactory. The shapes of cysts were not the significant factor affecting the surgical outcome, but the surgical outcome of the cystiform group was significant.
出处
《临床小儿外科杂志》
CAS
2012年第1期7-9,27,共4页
Journal of Clinical Pediatric Surgery
