腹腔镜与开放手术治疗成人先天性胆管扩张症的疗效对比

目的 探讨完全腹腔镜下胆管囊肿切除、肝总管空肠Roux-en-Y吻合术治疗成人先天性胆管扩张症的可行性、安全性,并与传统开放手术的疗效进行比较.方法 回顾性分析2008年5月至2011年9月期间中国医科大学附属盛京医院普外科收治的33例先天性胆管扩张症患者的临床资料.其中14例患者接受完全腹腔镜下胆管囊肿切除、肝总管空肠Roux-en-Y吻合术(腹腔镜手术组),19例患者接受传统开放手术(传统手术组).结果 所有腹腔镜手术均顺利,无中转开腹.平均手术时间腹腔镜手术组长于传统手术组(195 min比130 min,P＜0.01),术中平均失血量腹腔镜手术组少于传统手术组(80 ml比270 ml,P＜0.01),术后平均排气时间和术后平均住院时间腹腔镜手术组均短于传统手术组(排气时间:76 h比104 h,P＜0.01；住院时间:6.1 d比9.6d,P＜0.01).术后早期并发症的发生率2组间差异无统计学意义(P＞0.05).腹腔镜手术组1例术后有少量胆汁漏,20～50 ml/d,保持引流通畅,1周后自行愈合；传统手术组1例术后3个月出现粘连性肠梗阻,保守治疗后缓解；余31例无严重术后并发症,均恢复顺利.术后随访3～40个月,平均14.5个月,所有患者无腹痛、发热或黄疸等症状.结论 完全腹腔镜下胆管囊肿切除、肝总管空肠Roux-en-Y吻合术安全、可行,具有创伤小、恢复快的优点.

Comparison of Therapeutic Effects of Laparoscopic Versus Open Operation in Treatment for Adult Congenital Cholangiectasis

Objective To explore the feasibility and safety of laparoscopic cyst resection and Roux-en-Y hepatojejunostomy in treatment for adult congenital cholangiectasis and to compare the therapeutic effects of laparoscopic procedure with conventional open procedure.Methods The clinical data of 33 adult patients with congenital cholangiectasis from May 2008 to September 2011 in the department of general surgery of Shengjing Hospital of China Medical University were retrospectively analyzed.Fourteen patients received laparoscopic procedure(laparoscopic group),whereas the other 19 patients received conventional open procedure(conventional group).Results All the operations were carried out successfully through laparoscopic procedure.The mean time of operation in the laparoscopic group was significantly longer than that in the conventional group(195 min versus 130 min,P<0.01).The average intraoperative blood loss in the laparoscopic group was significantly less than that in the conventional group(80 ml versus 270 ml,P < 0.01).In contrast,the mean time of bowel peristalsis recovery and postoperative hospital stay in the laparoscopic group were significantly shorter than those in the conventional group(time of bowel motion recovery:76 h versus 104 h,P < 0.01;hospital stay:6.1 d versus 9.6 d,P < 0.01).There were no differences in the early complications between two groups(P > 0.05).Conclusions Totally laparoscopic treatment for congenital cholangiectasis in adult is feasible and safe.It is worth to be generally applied because of its minimal invasion and fast postoperative recovery.