胆总管囊肿穿孔引流术后二次腹腔镜根治切除的病例回顾及疗效分析OA

Objective To explore the feasibility and efficacy of secondary laparoscopic radical resection following T-tube drainage for spontaneous perforation of congenital choledochal cysts in children,and to summarize the ex-perience with laparoscopic surgery.Methods A retrospective analysis was performed on the clinical data of chil-dren diagnosed with congenital common bile duct cyst perforation stage 1 T-tube extraductal drainage and second-ary laparoscopic radical resection in the Department of Pediatric General Surgery of the Affiliated Hospital of Zu-nyi Medical University from January 2017 to December 2024.Results This study included 13 patients(5 males,8 females)with a mean age of 18 months(range:3～84 months).The initial T-tube external drainage was per-formed using an open approach in 6 cases and using a laparoscopic approach in 7 cases.The time interval be-tween the second radical surgery and T-tube drainage procedure was 3 to 6 months,with an average of 3.5 months.The cyst diameter ranged from 2.5 to 5 cm.Intraoperative cholangiography revealed concomitant pan-creaticobiliary maljunction in one patient.Three patients with a narrow common hepatic duct(approximately 3 mm in diameter)underwent ductoplasty followed by hepaticojejunostomy.All 13 patients successfully underwent secondary radical resection using a laparoscopic approach.The operative time ranged from 190 to 280 minutes,with an estimated blood loss ranging from 20 to 100 ml.Postoperatively,one patient developed bile leakage,which was resolved with conservative management.No other complications such as hemorrhage,pancreatic fistu-la,intestinal obstruction,or intra-abdominal infection were observed.The postoperative hospital stay ranged from 8 to 10 days.During the follow-up period of 3 months to 2 years,all patients recovered well.Conclusion Sec-ondary laparoscopic radical resection performed after initial drainage for perforated choledochal cysts is safe and feasible.Despite significant hilar adhesions,this procedure can be successfully carried out by surgeons experi-enced in complex laparoscopic hepatobiliary surgery.