经脐单孔与传统四孔法腹腔镜手术治疗儿童胆总管囊肿的对比研究OA北大核心

Objective To compare clinical application value of transumbilical single-port laparoscopic hepaticojejunostomy(TUSPLH)versus conventional four-port laparoscopic hepaticojejunostomy(CLH)for children with choledochal cyst using conventional laparoscopic instruments.Methods From June 2019 to De-cember 2022,87 children with choledochal cyst were hospitalized.According to the inclusion criteria,the clini-cal data of 85 children were retrospectively reviewed.Forty-four children underwent TUSPLH while another 41 children CLH.Baseline profiles,operative findings and curative outcomes were compared between two groups.Results All operation were successfully completed.Age[(54.7±22.2)vs.(49.7±20.0)month,t=1.087,P=0.280],volume of blood loss[(5.4±1.1)vs.(5.8±1.5)mL,t=-1.544,P=0.126],drain-age tubing rate[19.5％(8/41)vs.11.4％(5/44),x2=1.088,P=0.297],intestinal function recovery time[(15.9±5.8)vs.(17.8±6.3)h,t=-1.446,P=0.152],postoperative hospital stay[(7.3±2.1)vs.(6.9±1.6)day,t=1.086,P=0.281]and complication rate[2.4％(1/41)vs.2.3％(1/44),P=1.000]showed no significant inter-group difference.The inter-group differences in operative duration[(195.7±41.4)vs.(255.4±53.9)min,t=-5.693,P＜0.001],pain score[(4.0±1.4)vs.(3.3±1.0),t=2.826,P=10.006]and incision healing satisfaction score[(8.5±0.7)vs.(9.3±0.4),t=-6.365,P＜0.001]differed significantly.One child in TUSPLH group experienced postoperative bile leakage and healed after 12-day abdominal drainage.Another child in CLH group had postoperative hemorrhage.Emergency laparoscopic ex-ploration revealed hemorrhage of cyst separation surface.After surgical hemostasis,the child recovered smooth-ly.The remainders had no onset of such complications as anastomotic stenosis,cholangitis or pancreatitis.No mortality occurred in neither groups.Conclusions For pediatric choledochal cyst,both TUSPLH and CLH with conventional laparoscopic instruments may achieve similar short/middle-term outcomes.The former offers a satisfactory cosmetic incision and milder postoperative pain.However,there are greater surgical difficulty and longer operative duration.For recurrent preoperative biliary tract infections and imaging findings necessitating intraoperative cholangioplasty,TUSPLH should be performed with more caution.