胆总管囊肿切除胆道重建术的术后近期并发症

目的探讨胆总管囊肿的手术并发症及其预防和治疗的措施.方法对10年中173例年龄27d至14岁患儿行胆总管囊肿切除胆道重建术后出现近期手术并发症的16例行回顾性研究,分析各种并发症的临床表现,预防和治疗方法,以及并发症与年龄和术式的关系.结果手术并发症发生率9.3%(16/173).16例并发症中包括胆瘘10例,腹壁伤口裂开3例,胰瘘、术后小肠套叠和肝功能衰竭各1例.1岁以下婴儿手术并发症发生率明显高于1岁以上儿童(χ2=15.78,P＜0.01).囊肿切除后空肠间置代胆道与肝总管空肠Roux-Y吻合2种胆道重建术式的并发症发生率差异无显著性意义(χ2=0.07,P＞0.05).因并发症死亡者4例,包括胆瘘3例和术后肝功能衰竭1例,手术病死率2.3%(4/173).胆瘘死亡病例与未及时再手术有关,术后肝功能衰竭与术前黄疸和胆道感染不能控制有关.结论胆瘘、腹壁裂开和肝功能衰竭是胆总管囊肿切除、胆道重建术的主要并发症,1岁以下婴儿并发症发生率较高,尤应注意术前充分控制胆道感染、改善肝功能和提高手术操作技巧.胆瘘以早期手术修补为宜,应防止胆道的二重感染.筋膜层平面的减张缝合可有效地预防和治疗腹壁伤口裂开.

Early postoperative complications of choledochal cyst excision and reconstruction of biliary tract

OBJECTIVE: To study the early postoperative complications of choledochal cyst excision with reconstruction of the biliary tract. METHODS: In last 10 years, 173 patients aged from 27 days to 14 years (mean = 2.4 years) were operated on with procedures of choledochal cyst excision and biliary tract reconstruction by jejunointerposition between the liver hilum and duodenum or Roux-en-Y hepaticojejunostomy in our hospital. Amongst these 173 patients, 16 were found to suffer from postoperative complications. Therefore, their clinical data were retrospectively analyzed, and the prevention and treatment of the early postoperative complications discussed. RESULTS: The morbidity of early postoperative complications was 9.3% (16/173). The early complications included biliary leakage in 10 patients, wound dehiscence of abdominal wall in 3, hepatic failure in 1, pancreatic fistula in 1, and postoperative enteric intussusception in 1. The morbidity of early postoperative complications in infants younger than 1-year old was significantly higher than that in children(chi 2 = 15.78, P < 0.01). However, there was no significant difference in the morbidity of early postoperative complications between patients undergoing biliary tract reconstruction by jejunal segment interposition and those undergoing that by Roux-en-Y hepaticojejunostomy (chi 2 = 0.07, P > 0.05). The total mortality in all the operated patients was 2.3% (4/173). Three patients died from biliary leakage and 1 from postoperative hepatic failure. CONCLUSIONS: Biliary leakage, wound dehiscence of abdominal wall and hepatic failure are major early postoperative complications. The morbidity in infants younger than 1-year old is higher than in children. The preoperative treatment of biliary tract infection, hypohepatia, and surgical skills during operation should be emphasized. Reoperation for biliary leakage should not be delayed and mycotic cholangitis after biliary leakage needs more attention. Tension suture in the fascial space of the abdominal wall is useful for the prevention and treatment of abdominal wall dehiscence.