摘要
目的探讨Kasai肝门肠吻合术中个体化短Roux空肠袢对Ⅲ型胆道闭锁患儿预后的影响。方法回顾性分析2012年1月至2016年6月于本院行Kasai手术的166例Ⅲ型胆道闭锁患儿临床资料。根据术中胆道重建Roux空肠袢长度分为两组,91例按常规采用30~40 cm长的Roux空肠袢,为长袢组;75例依据脐与肝门距离个体化选择Roux空肠袢长度,为短袢组。术后均采取电话及门诊随访,随访时间3~50个月,随访内容包括体格检查、腹部彩超、实验室检查及上消化道造影等。结果短袢组Roux支平均长度(17.42±3.91)cm,长袢组Roux支平均长度(32.87±3.91)cm,两组差异有统计学意义(t=14.72,P=0.00)。两组在年龄、手术时间、术中出血、术后住院及引流时间方面比较差异无统计学意义(P值均>0.05)。长袢组术后6个月黄疸引流率为68.1%(62/91),短袢组为73.3%(55/75),差异无统计学意义(χ~2=0.54,P=0.47)。短袢组总体并发症发生率(胆漏、肠梗阻、吻合口狭窄、上消化道出血等)较长袢组低(5.3%vs 6.6%),差异无统计学意义(χ~2=0.00,P=0.99)。随访期间,短袢组术后胆管炎的发生率(19/75,25.3%)较长袢组(29/91,31.9%)低,差异无统计学意义(χ~2=2.973,P=0.085)。两组Kaplan-Meier生存曲线显示术后自体肝生存率差异无统计学意义(χ~2=0.66,P=0.42)。结论与传统的长Roux空肠袢相比,Kasai肝门肠吻合术中采用个体化的短Roux空肠袢进行胆道重建,同样能有效抗反流和降低术后胆管炎的发生率,且能节约小肠组织,有利于患儿术后康复。
Objective To explore the long-term efficacy of individualized short Roux loop on patient outcomes during Kasai portoenterostomy in infants with typeⅢbiliary atresia(BA)MethodsThe clinical data of166patients with typeⅢBA undergoing Kasai portoenterostomy at Capital Pediatric Institution between January2011to June2016were retrospectively analyzed According to the length of Roux loop,they were divided into long Roux loop group(LRLG,n=91)and short Roux loop group(SRLG,n=75).Conventional30~40cm Roux loop was used for LRLG while Roux loop length depended upon the distance between hepatic hilum and umbilcus for SRLG During a follow-up period of3to50months,ultrasonography,upper gastrointestinal contrast and laboratory tests were performed ResultsThe mean Roux loop length of SRLG was significantly shorter than that of LRLG(P[WTBZ〗<005)No ignificant inter group differences existed in age,operative duration,intraoperative volume of blood loss,postoperative hospital stay or duration of drainage The rate of bile drainage was lower in SLG than that in LLG However,there was no significant difference(P<005)The incidence rates of such postoperative complications as bile leakage,intestinal obstruction,anastomotic stenosis and esophageal varices bleedingwas higher in LLRG than those in SRLG However,there were no significant differences(P>005)During follow ups,the occurrence rate of postoperative cholangitis of two group was similar(P>005)The survival curve of native liver survival rate showed no inter-group difference according to the Kaplan Meier method ConclusionAs compared with LLG,individualized short Roux loop length is effective for anti-reflux It can save bowel tissue,accelerate recovery and reduce the occurrence of related complications during Kasai portoenterostomy
作者
肖辉
陈龙
刘树立
李龙
Xiao Hui;Chen Long;Liu Shuli;Li Long(Department of Pediatric Surgery,Capital Institute of Pediatrics,Beijing 100020,China;Graduate School,Peking Union Medical College,Beijing 100730,China)
出处
《临床小儿外科杂志》
CAS
2017年第4期355-359,共5页
Journal of Clinical Pediatric Surgery
基金
北京市医院管理局重点医学专业发展计划(编号:ZYLX201306)
小儿腔镜诊断治疗先天畸形技术规范
标准及新技术评价研究(201402007)
