학술논문
短Roux-Y空肠支在Ⅲ型胆道闭锁Kasai肝门肠吻合术中的应用 / Application of individualized short Roux loop for Kasai portoenterostomy in infants with type Ⅲ biliary atresia
Document Type
Academic Journal
Source
临床小儿外科杂志 / Journal of Clinical Pediatric Surgery. 16(4):355-359
Subject
Language
Chinese
ISSN
1671-6353
Abstract
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(=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(x2=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％ vs6.6％),差异无统计学意义(x2=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(x2=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(x2=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 type Ⅲ biliary atresia (BA).Methods The clinical data of 166 patients with type Ⅲ BA undergoing Kasai portoenterostomy at Capital Pediatric Institution between January 2011 to June 2016 were 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).Conventional 30～ 40 cm 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 of 3 to 50 months,ultrasonography,upper gastrointestinal contrast and laboratory tests were performed.Results The mean Roux loop length of SRLG was significantly shorter than that of LRLG(P ＜ 0.05).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 ＜ 0.05).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 ＞ 0.05).During follow-ups,the occurrence rate of postoperative cholangitis of two group was similar (P ＞0.05).The survival curve of native liver survival rate showed no inter-group difference according to the Kaplan-Meier method.Conclusion As 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.
Objective To explore the long-term efficacy of individualized short Roux loop on patient outcomes during Kasai portoenterostomy in infants with type Ⅲ biliary atresia (BA).Methods The clinical data of 166 patients with type Ⅲ BA undergoing Kasai portoenterostomy at Capital Pediatric Institution between January 2011 to June 2016 were 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).Conventional 30～ 40 cm 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 of 3 to 50 months,ultrasonography,upper gastrointestinal contrast and laboratory tests were performed.Results The mean Roux loop length of SRLG was significantly shorter than that of LRLG(P ＜ 0.05).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 ＜ 0.05).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 ＞ 0.05).During follow-ups,the occurrence rate of postoperative cholangitis of two group was similar (P ＞0.05).The survival curve of native liver survival rate showed no inter-group difference according to the Kaplan-Meier method.Conclusion As 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.