肝門部纖維板塊對膽道閉鎖腹腔鏡手術的影響分析

吳宙光　王斌　馮奇等

[摘要] 目的 探討膽道閉鎖患兒有無肝門部纖維板塊對腹腔鏡Kasai術的影響。 方法 回顧性分析2011年1月～2015年1月深圳市兒童醫院經腹腔鏡Kasai術治療的Ⅲ型膽道閉鎖患兒69例，根據術中探查有無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，肝門部未見明顯纖維板塊22例為對照組。比較兩組的肝門部切除平面面積、手術時間、術中出血量、中轉開放率、術后轉入PICU病房率等數據。 結果 研究組肝門部切除平面面積[（6.1±1.8）cm2]大于對照組[（4.1±1.5）cm2]，差異有統計學意義（P < 0.05）；研究組手術時間[（4.8±1.8）h]及術中出血量[（37.0±11.2）mL]均多于對照組[（3.4±1.2）h、（25.0±10.8）mL]，差異有統計學意義（P < 0.05）；研究組術后轉入PICU病房率（40.4%）高于對照組（18.2%），差異有統計學意義（P < 0.05）；但兩組中轉開放手術率比較（4.3%比4.5%），差異無統計學意義（P > 0.05）。 結論 對于有肝門部纖維板塊的膽道閉鎖，腹腔鏡Kasai術在肝門部切除的面積較廣，手術難度及手術風險更大，術中需更加謹慎。

[關鍵詞] 膽道閉鎖；腹腔鏡；Kasai術；肝門

[中圖分類號] R726.5 [文獻標識碼] A [文章編號] 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）是兒童最常見的嚴重肝臟疾病，以肝內和肝外膽管進行性炎癥和纖維性梗阻為特征，從而導致膽汁排泄障礙以及進行性的肝纖維化[1]。按日本小兒外科學會分類方法，膽道閉鎖可分為三個類型，其中最常見的是以肝門部閉鎖為主要表現的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，另一類為肝門部無纖維板塊組織[3]。Kasai術是當前治療Ⅲ型膽道閉鎖的重要手段。隨著微創外科技術的發展，腹腔鏡Kasai術的報道越來越多，Ⅲ型膽道閉鎖的腹腔鏡手術以其微創及精準的解剖視野優勢，已逐漸受學界的重視[4]。越來越多的研究表明，肝門部存在纖維板塊組織的膽道閉鎖，Kasai術后預后較好[5-6]。因此，有必要對該類型的膽道閉鎖腹腔鏡手術進行研究。本文將回顧性分析深圳市兒童醫院（以下簡稱“我院”）收治的Ⅲ型膽道閉鎖腹腔鏡手術69例病例，探討肝門部纖維板塊對腹腔鏡Kasai術的影響。現將結果報道如下：