CAJ | 학술논문

目的：探讨胆道闭锁患儿有无肝门部纤维板块对腹腔镜Kasai术的影响。方法回顾性分析2011年1月~2015年1月深圳市儿童医院经腹腔镜Kasai术治疗的芋型胆道闭锁患儿69例，根据术中探查有无肝门部纤维板块将其分为两组，其中肝门部存在纤维板块47例为研究组，肝门部未见明显纤维板块22例为对照组。比较两组的肝门部切除平面面积、手术时间、术中出血量、中转开放率、术后转入PICU病房率等数据。结果研究组肝门部切除平面面积[(6.1±1.8)cm2]大于对照组[(4.1±1.5)cm2]，差异有统计学意义(P<0.05)；研究组手术时间[(4.8±1.8)h]及术中出血量[(37.0±11.2)mL]均多于对照组[(3.4±1.2)h、(25.0±10.8)mL]，差异有统计学意义(P<0.05)；研究组术后转入PICU病房率(40.4%)高于对照组(18.2%)，差异有统计学意义(P<0.05)；但两组中转开放手术率比较(4.3%比4.5%)，差异无统计学意义(P>0.05)。结论对于有肝门部纤维板块的胆道闭锁，腹腔镜Kasai术在肝门部切除的面积较广，手术难度及手术风险更大，术中需更加谨慎。
목적：탐토담도폐쇄환인유무간문부섬유판괴대복강경Kasai술적영향。방법회고성분석2011년1월~2015년1월심수시인동의원경복강경Kasai술치료적우형담도폐쇄환인69례，근거술중탐사유무간문부섬유판괴장기분위량조，기중간문부존재섬유판괴47례위연구조，간문부미견명현섬유판괴22례위대조조。비교량조적간문부절제평면면적、수술시간、술중출혈량、중전개방솔、술후전입PICU병방솔등수거。결과연구조간문부절제평면면적[(6.1±1.8)cm2]대우대조조[(4.1±1.5)cm2]，차이유통계학의의(P<0.05)；연구조수술시간[(4.8±1.8)h]급술중출혈량[(37.0±11.2)mL]균다우대조조[(3.4±1.2)h、(25.0±10.8)mL]，차이유통계학의의(P<0.05)；연구조술후전입PICU병방솔(40.4%)고우대조조(18.2%)，차이유통계학의의(P<0.05)；단량조중전개방수술솔비교(4.3%비4.5%)，차이무통계학의의(P>0.05)。결론대우유간문부섬유판괴적담도폐쇄，복강경Kasai술재간문부절제적면적교엄，수술난도급수술풍험경대，술중수경가근신。
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, opera-tion 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 dif-ficult, the risk of operation is higher and should be paid more attention to the operation process.