肝門部纖維板塊對(duì)膽道閉鎖腹腔鏡手術(shù)的影響分析

吳宙光　王斌　馮奇等

[摘要] 目的 探討膽道閉鎖患兒有無(wú)肝門部纖維板塊對(duì)腹腔鏡Kasai術(shù)的影響。 方法 回顧性分析2011年1月～2015年1月深圳市兒童醫(yī)院經(jīng)腹腔鏡Kasai術(shù)治療的Ⅲ型膽道閉鎖患兒69例，根據(jù)術(shù)中探查有無(wú)肝門部纖維板塊將其分為兩組，其中肝門部存在纖維板塊47例為研究組，肝門部未見(jiàn)明顯纖維板塊22例為對(duì)照組。比較兩組的肝門部切除平面面積、手術(shù)時(shí)間、術(shù)中出血量、中轉(zhuǎn)開(kāi)放率、術(shù)后轉(zhuǎn)入PICU病房率等數(shù)據(jù)。 結(jié)果 研究組肝門部切除平面面積[（6.1±1.8）cm2]大于對(duì)照組[（4.1±1.5）cm2]，差異有統(tǒng)計(jì)學(xué)意義（P < 0.05）；研究組手術(shù)時(shí)間[（4.8±1.8）h]及術(shù)中出血量[（37.0±11.2）mL]均多于對(duì)照組[（3.4±1.2）h、（25.0±10.8）mL]，差異有統(tǒng)計(jì)學(xué)意義（P < 0.05）；研究組術(shù)后轉(zhuǎn)入PICU病房率（40.4%）高于對(duì)照組（18.2%），差異有統(tǒng)計(jì)學(xué)意義（P < 0.05）；但兩組中轉(zhuǎn)開(kāi)放手術(shù)率比較（4.3%比4.5%），差異無(wú)統(tǒng)計(jì)學(xué)意義（P > 0.05）。 結(jié)論 對(duì)于有肝門部纖維板塊的膽道閉鎖，腹腔鏡Kasai術(shù)在肝門部切除的面積較廣，手術(shù)難度及手術(shù)風(fēng)險(xiǎn)更大，術(shù)中需更加謹(jǐn)慎。

[關(guān)鍵詞] 膽道閉鎖；腹腔鏡；Kasai術(shù)；肝門

[中圖分類號(hào)] R726.5 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-7210（2015）08（c）-0018-04

[Abstract] Objective To explore the effect of biliary atresia on laparoscopic Kasai operation for children with and without hilar fiber plate. Methods From January 2011 to January 2015 in Shenzhen， Children's Hospital， 69 children with type Ⅲ biliary atresia underwent laparoscopic Kasai operation were selected， according to whether intraoperative detection without hilar fiber plate or not， they were divided into two groups， 47 cases of hilar existing fiber plate were as study group， and 22 cases of no obvious fiber plate in hilar were as control group. Hilar resection plane area， operation time， amount of bleeding during operation， conversion to open rate and postoperation transferred to PICU ward rate of two groups were compared. Results hilar average resection plane area of study group [（6.1±1.8）cm2] was more than that of control group [（4.1±1.5）cm2]， the difference was statistically significant （P < 0.05）； operation time [（4.8±1.8）h] and intraoperative bleeding [（37.0±11.2）mL] were more than those of control group [（3.4±1.2）h， （25.0±10.8）mL]， the differences were statistically significant （P < 0.05）； postoperation transferred to the PICU ward rate （40.4%） was higher than that of control group （18.2%）， the differences were statistically significant （P < 0.05）； but conversion to open rate of two groups were compared， the difference was not statistically significant （P > 0.05）. Conclusion For the biliary atresia which has hilar fiber plate， the hilar resection area in laparoscopic Kasai operation is broader， the operation is more difficult， the risk of operation is higher and should be paid more attention to the operation process.

[Key words] Biliary atresia； Laparoscopy； Kasai operation； Hilar

膽道閉鎖（biliary atresia，BA）是兒童最常見(jiàn)的嚴(yán)重肝臟疾病，以肝內(nèi)和肝外膽管進(jìn)行性炎癥和纖維性梗阻為特征，從而導(dǎo)致膽汁排泄障礙以及進(jìn)行性的肝纖維化[1]。按日本小兒外科學(xué)會(huì)分類方法，膽道閉鎖可分為三個(gè)類型，其中最常見(jiàn)的是以肝門部閉鎖為主要表現(xiàn)的Ⅲ型膽道閉鎖，比例大約占膽道閉鎖患兒的84.1%[2]。而Ⅲ型膽道閉鎖根據(jù)其肝門部上的病理解剖可分為兩類，一類為肝門部存在纖維板塊組織，另一類為肝門部無(wú)纖維板塊組織[3]。Kasai術(shù)是當(dāng)前治療Ⅲ型膽道閉鎖的重要手段。隨著微創(chuàng)外科技術(shù)的發(fā)展，腹腔鏡Kasai術(shù)的報(bào)道越來(lái)越多，Ⅲ型膽道閉鎖的腹腔鏡手術(shù)以其微創(chuàng)及精準(zhǔn)的解剖視野優(yōu)勢(shì)，已逐漸受學(xué)界的重視[4]。越來(lái)越多的研究表明，肝門部存在纖維板塊組織的膽道閉鎖，Kasai術(shù)后預(yù)后較好[5-6]。因此，有必要對(duì)該類型的膽道閉鎖腹腔鏡手術(shù)進(jìn)行研究。本文將回顧性分析深圳市兒童醫(yī)院（以下簡(jiǎn)稱“我院”）收治的Ⅲ型膽道閉鎖腹腔鏡手術(shù)69例病例，探討肝門部纖維板塊對(duì)腹腔鏡Kasai術(shù)的影響。現(xiàn)將結(jié)果報(bào)道如下：