IR@PKUHSC  > 北京大学第一临床医学院
其他题名Investigation of laparoscopic treatment for blliary atresia of type Ⅰ or Ⅱ
刘树立1; 李龙1; 王文雅1; 侯文英1; 黄柳明1; 周小龙1; 张军1; 王莹1; 李旭1
关键词胆道闭锁 腹腔镜 Biliary Atresia 外科手术 Biliary Cyst 微创性 Laparoscopes Surgical Procedures Minimally Invasive
收录类别中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型Journal Article
摘要目的 对经腹腔镜手术治疗Ⅰ型及Ⅱ型胆道闭锁的效果进行探讨.方法 自2003年3月至2007年7月,共收治患Ⅰ型及Ⅱ型胆道闭锁并胆管囊性扩张的患儿10例,其中Ⅰ型8例,Ⅱ型2例;男4例,女6例;年龄23~160 d,平均53.8 d.患儿均有黄疸、陶土样便等症状;伴有总胆红素、转氨酶明显升高;术前经B超等影像学检查证实有肝门部囊性扩张的胆管存在,平均直径1.5 cm(1.0~1.8 cm);10例经术中证实为Ⅰ、Ⅱ型胆道闭锁伴有肝外胆道囊性扩张.本组10例患儿行经腹腔镜扩张的胆管底部切除胆管空肠Roux-en-Y吻合术.术后平均随访26个月(4~51个月).结果 本组10例患儿行经腹腔镜手术全部成功,无中转开腹.手术时间平均为3.0 h(2.4~3.2 h),术中出血量5~10ml.术后胃肠平均通气时间为18 h(16~28 h),进食时间平均20 h(16~30 h);平均术后3 d(2~4 d)排黄色大便;腹腔引流放置时间平均58 h(48~72 h),平均术后10 d(7~16 d)黄疸减轻,6例患儿术后14 d总胆红素直接胆红素降至正常水平,3例患儿3个月降至正常水平,1例手术年龄5.5个月患儿虽获良好胆汁引流,胆红素水平有所降低,但因肝硬化严重,后来仍维持高水平,胆汁引流后肝功能改善不佳,术后28 d死于肝功能衰竭.转氨酶术后不同程度的下降.术后平均住院时间6.8 d(5~9 d).术后随访4~51个月,1例患儿于术后4周发生胆管炎,经抗炎后痊愈.其余患儿肝功能各项指标均正常,无胆管炎、吻合口狭窄、粘连肠梗阻等术后并发症.结论 经腹腔镜囊性扩张的胆管底部切除胆管空肠吻合术治疗Ⅰ、Ⅱ型胆道闭锁是一种安全有效、可靠的方法. Objective To investigate the feasibility and safety of laparoscopic Roux-en-Y hepatojejunostomy for curable biliary atresia(BA of type Ⅰ or Ⅱ). Methods From April 2003 to July 2007, the group enrolled 10 children suffering BA of type Ⅰ or Ⅱ with the manifestations of persistant jaundice, white stools and abnormal high level of AST and ALT. Six cases were girls, and 4 were boys. The mean age of patients were 53. 8 days (ranged from 23 days to 160 days). Six cases were diagnosed as type Ⅰ , and 4 with type Ⅱ, all of whose hepatic portal biliary tract were verified to have cystic dilatation by imaging examination, with the average diameter of 1.5 cm (ranged from 1.0 to 2.0 cm). After proved intraoperatively, the 10 children underwent laparoscopic cyst excision with Rouxen-Y hepatojejunostomy. All cases were followed up at a mean period of 26 months (ranged from 4 to 51 months). Results All cases were managed to perform laparoscopic operations without conversion to open laparotomy. Average duration of operations was 3.0 hours (ranging from 2.4 to 3.2 hours) without intraoperative complications, intraoperative bleeding was 5 to 10 ml without necessity for blood transfusion. The mean postoperative flatus time was 18 hours (ranging from 16 to 28 hours), postoperative oral food intake was 20 hours (ranged from 16 to 30 hours), bile stained stools were defecated on day 3 (ranged from 2 to 4 days) postoperatively. Abdominal drainage sustained at the average time of 58 hours (ranged from 48 to 72 hours). Jaundice appeared to reduce at day 10 (ranged from 7 to16 days) postoperatively. Total and direct bilirubin of 3 patients decreased to normal within 3 months. One infant with. the age of 5. 5 months died at 28 days after operation for hepatic failure caused by severe hepatic cirrhosis, although whose bile was well drained and bilirubin decreased once but elevated later again. ALT and AST of all patients decreased to different levels. The postoperative course was uneventful in other 9 patients with the hospital stay of 6. 8 days (ranged from 5 to 9 days) after operations. Data of follow-up showed no postoperative complication such as abnormal hepatic function, cholangitis, stoma stenosis or adhesive bowel obstruction, except one children got cholangitis 4 weeks after the operation who was then cured by anti-inflammatory treatment. Conclusions Laparoscopic cyst excision with Roux-en-Y hepatojejunostomy for children with type Ⅰ or Ⅱ biliary atresia is feasible, safe and effective.
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GB/T 7714
刘树立,李龙,王文雅,等. 经腹腔镜手术治疗Ⅰ、Ⅱ型胆道闭锁[J]. 中华小儿外科杂志,2008,29(10):610-614.
APA 刘树立.,李龙.,王文雅.,侯文英.,黄柳明.,...&李旭.(2008).经腹腔镜手术治疗Ⅰ、Ⅱ型胆道闭锁.中华小儿外科杂志,29(10),610-614.
MLA 刘树立,et al."经腹腔镜手术治疗Ⅰ、Ⅱ型胆道闭锁".中华小儿外科杂志 29.10(2008):610-614.
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