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首页> 外文期刊>Surgical Endoscopy >Laparoscopic-assisted cyst excision and ductoplasty plus widened portoenterostomy for choledochal cysts with a narrow portal bile duct
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Laparoscopic-assisted cyst excision and ductoplasty plus widened portoenterostomy for choledochal cysts with a narrow portal bile duct

机译：腹腔镜辅助囊肿切除和导管成形术加加宽了胆固色囊肿的胆囊囊肿，狭窄的门静脉管道

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摘要

BackgroundComplete cyst excision with Roux-en-Y hepaticojejunostomy is the standard procedure for choledochal cysts (CCs). In recent years, neonates have been increasingly diagnosed with CCs prenatally. Earlier treatment has been recommended to avoid complications. For type IVa malformation without extensive intrahepatic bile duct dilatation, laparoscopic hepaticojejunostomy is technically challenging, and anastomotic stricture is a concern. Therefore, we propose laparoscopic synthetical techniqueslaparoscopic excision of cyst and ductoplasty plus widened portoenterostomy to avoid stricture in CCs with a narrow hilar duct.MethodsAn anastomosis was created around the transected end of the common bile duct in 12 minipigs (Group A), and another 12 minipigs (Group B) received conventional cholangiojejunostomy. Anastomotic diameter measurements and cholangiography were conducted at different times. Histological findings of inflammation and scarring were compared. The expression levels of TGF-1 and type I collagen were detected by real-time quantitative PCR. Between January 2012 and January 2016, laparoscopic excision of cyst and ductoplasty plus widened portoenterostomy were performed on 29 children with confirmed CCs with a narrow portal bile duct who were followed up for 12-48months.ResultsGroup A survived well without obstruction. Slight inflammation and fibrotic tissue were confined to the bile duct periphery. In Group B, five pigs developed stricture. Severe inflammation and diffuse fibrosis affected the whole layer of the anastomosis. Fibrotic biomarkers were significantly higher postoperatively in Group B. Clinically, 29 patients exhibited satisfactory outcomes. No anastomotic stricture has been observed to date.ConclusionsLaparoscopic synthetical techniques may be a superior option to prevent anastomotic stricture in treating CCs with a narrow portal bile duct.
机译：背景技术与Roux-Zh-y Hepaticojejunostomy的ColeSt切除是Choledochal囊肿（CCS）的标准程序。近年来，新生儿已经越来越诊断出CCS原因。提前治疗建议避免并发症。对于IVA型畸形而无需广泛的肝内胆管扩张，腹腔镜肝脏jenoStomy在技术上是挑战性的，并且吻合狭窄是一个问题。因此，我们提出了腹腔镜综合技术囊肿切除囊肿和转导术加扩大的门外术，以避免CCS的狭窄，狭窄的蚕门管道。在12微分剂（A组）的常见胆管的透露末端围绕常见的胆管切断的吻合术。 MINIPIGS（B组）接受常规的Cholangiojejunostomy。在不同的时间进行吻合直径测量和胆管造影。比较了炎症和瘢痕的组织学结果。通过实时定量PCR检测TGF-1和I型胶原蛋白的表达水平。 2012年1月至2016年1月期间，囊肿和转导术加宽的腹腔镜切除术术中29名儿童进行了狭窄的门静脉管道，随访12-48个月。康复，没有障碍物，没有障碍。轻微的炎症和纤维化组织被限制在胆管周边。在B组中，五只猪发育了狭窄。严重的炎症和弥漫性纤维化影响了整个吻合层的整体层。 B组术后脊髓纤维化生物标志物显着提高。临床上，29名患者表现出令人满意的结果。没有观察到迄今为止的吻合体狭窄。结论腹腔镜综合技术可能是一种优异的选择，以防止用狭窄的门胆管治疗CCS治疗CCS。

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  • 来源
    《Surgical Endoscopy》 |2019年第6期|共10页
  • 作者

    Chang Xiaopan; Zhang Xi; Xiong Meng; Yang Li; Li Shuai; Cao Guoqing; Zhou Ying; Yang Dehua; Tang Shao-tao;

  • 作者单位

    Huazhong Univ Sci &

    Technol Union Hosp Tongji Med Coll Dept Pediat Surg Wuhan 430022 Hubei;

    Huazhong Univ Sci &

    Technol Union Hosp Tongji Med Coll Dept Pediat Surg Wuhan 430022 Hubei;

    Huazhong Univ Sci &

    Technol Union Hosp Tongji Med Coll Dept Pediat Surg Wuhan 430022 Hubei;

    Huazhong Univ Sci &

    Technol Union Hosp Tongji Med Coll Dept Pediat Surg Wuhan 430022 Hubei;

    Huazhong Univ Sci &

    Technol Union Hosp Tongji Med Coll Dept Pediat Surg Wuhan 430022 Hubei;

    Huazhong Univ Sci &

    Technol Union Hosp Tongji Med Coll Dept Pediat Surg Wuhan 430022 Hubei;

    Huazhong Univ Sci &

    Technol Union Hosp Tongji Med Coll Dept Pediat Surg Wuhan 430022 Hubei;

    Huazhong Univ Sci &

    Technol Union Hosp Tongji Med Coll Dept Pediat Surg Wuhan 430022 Hubei;

    Huazhong Univ Sci &

    Technol Union Hosp Tongji Med Coll Dept Pediat Surg Wuhan 430022 Hubei;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 诊断学;
  • 关键词

    Laparoscopy; Wide hepaticojejunostomy; Anastomotic stricture; Choledochal cyst;

    机译：腹腔镜检查;宽的肝脏jeunostomy;吻合体狭窄;Choledochal囊肿;

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