婴儿胆总管囊肿切除术——一项回顾性研究

胆总管囊肿是一种罕见的畸形，主要诊断为儿童。 唯一有效的治疗方法仍然是手术切除囊肿，然后进行 Roux-en-Y 肝空肠吻合术。 治疗无症状新生儿仍然是一个讨论点。 1984 年至 2021 年间，对 256 名儿童进行了胆总管囊肿 (CC) 切除术。 在这一组中，回顾性审查了 59 名在一岁以下接受手术的患者的病历。 随访时间为 0.3 至 18 年（中位数 3.9 年）。 22 例 (38%) 术前无症状，而 37 例 (62%) 术前有症状。 45 名患者 (76%) 的术后后期过程顺利。 在有症状的患者中，16% 有晚期并发症，而在无症状患者中，只有 4%。 剖腹手术组有 7 名患者 (17%) 出现了晚期并发症。 没有观察到腹腔镜组的晚期并发症。 早期手术干预不会带来并发症的高风险，并且可以防止术前并发症的发生，从而提供极好的早期和长期结果，尤其是在微创腹腔镜手术后。

胆总管囊肿是一种罕见的畸形，主要诊断为儿童。 随着超声检查的普及，越来越多的胆总管囊肿患者在症状出现前的产前或新生儿早期被诊断出来。 唯一有效的治疗方法仍然是手术切除囊肿，然后进行 Roux-en-Y 肝空肠吻合术。 治疗无症状新生儿仍然是一个讨论点。 通常，手术推迟到生命的第 3-6 个月，主要是由于新生儿和较小婴儿的 CC 切除困难。 然而，一些报告表明，即使在无症状患者中，新生儿 CC 也可能导致早期肝纤维化。 微创手术的引入并没有结束正在进行的讨论，因为一些手术中心提倡早期手术，而相比之下，其他手术中心推迟了干预时间，即使是在有症状的婴儿中，因为机器人手术进入的可能性较晚。 无论患者的年龄如何，明确的治疗原则都保持不变，包括完全切除囊肿和重建胆道。 在这项回顾性分析中，介绍了对 1 岁以下接受手术的 CC 患者进行手术治疗的经验。 旨在评估小婴儿的 CC 切除术是否安全、可行，并可能在治疗过程中提供额外的好处。

婴儿胆总管囊肿切除术——一项回顾性研究

图 1
端口放置：用于脐部 30° 腹腔镜的 10 毫米端口 (1)，以及三个 3-5 毫米的设备端口 (2-4)。 用于抬高镰状韧带 (A) 和胆囊 (B) 的经皮缝合。

婴儿胆总管囊肿切除术——一项回顾性研究

图 2
用间断的单丝可吸收缝线形成端对侧肝空肠吻合术。

婴儿胆总管囊肿切除术——一项回顾性研究

图 3
产前诊断的患者人数。

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