Comparative Study Of The Efficacy Of Laparoscopic Surgeryand Open Surgery In The Treatment Of Congenital Biliary Dilatation In Children

Objective: To compare the differences in perioperative related indexes of pediatric congenital biliary dilatation(CBD)with laparoscopic assisted and conventional open descending biliary resection and hepaticojejunostomy Roux-en-Y anastomosis.The advantages and disadvantages of the two surgical methods,evaluate the feasibility and safety of laparoscopic surgery,and provide reference for the choice of surgical methods for children with congenital biliary dilatation who need surgery.Methods: A retrospective analysis of 47 children with congenital biliary dilatation diagnosed as type I or IV admitted to the First Affiliated Hospital of Guangxi Medical University from January 2015 to October 2018.All patients underwent cholecystectomy and dilatation.Biliary tube resection,hepaticojejunostomy Roux-en-Y anastomosis,of which 20 patients underwent laparoscopic surgery(laparoscopic surgery group),27 patients underwent conventional open surgery(open surgery group),comparative analysis The operation time,intraoperative blood loss,postoperative gastric tube indwelling time,postoperative abdominal drainage tube indwelling time,totalhospitalization cost,relevant laboratory indexes before and after surgery,and postoperative complications were compared between the two groups.Results: There was no significant difference in the time of indwelling and postoperative hospital stay between the laparoscopic group and the open surgery group(t=-0.233,1.153,P=0.817,0.255).The operation time and intraoperative bleeding in the two groups.The difference in the amount of postoperative gastric tube indwelling time and total hospitalization cost were statistically significant(t=-4.845,3.560,5.185,-4.213,P values were less than 0.05).The average operation time of the laparoscopic surgery group was longer than that of the open surgery group.The total hospitalization cost was higher than that of the open surgery group,but the intraoperative blood loss and postoperative gastric tube indwelling time were better than the open surgery group.In the incidence of postoperative complications,1 case of acute cholangitis occurred in the open surgery group,2 cases of intestinal adhesions;2 cases of postoperative intestinal adhesion occurred in the laparoscopic surgery group;the difference of postoperative complications between the two groups There was no statistical significance(P>0.05).There were no significant differences in AST,ALT,ALP,and TBIL between the laparoscopic group and the open surgery group(t=-1.162,-1.562,0.540,0.895,P=0.251,0.132,0.592,0.376).There were no significant differences in post-AST,ALT,ALP,and TBIL contrasts(t=0.431,-0.957,-1.437,0.060,P=0.669,0.344,0.158,0.953).Conclusion: Compared with traditional open surgery for pediatric congenital biliary dilatation,laparoscopic surgery has the advantages of less intraoperative bleeding,less trauma,less surgical incision,and faster recovery of postoperative gastrointestinal function.The average operative time for laparoscopic surgery is significantly longer than open surgery,which may berelated to the surgeon’s proficiency in laparoscopic instrument operation.In conclusion,laparoscopic assisted dilatation of the bile duct and hepatic jejunal Roux-en-Y anastomosis for the treatment of congenital biliary dilatation in children is safe and effective,and has a clinical value.