| Background:Congenital bile duct cysts is a rare, abnormal biliary tree expansion disease, which is common in Asian women (F:M=4:1), most of the patients was found and diagnosed in infancy. There are obvious regional differences of the incidence of Choledochal cysts, the rate in Asian people is about1:5000, while in North America is around1:15.0000. Choledochal cysts have higher cancerization rate, and the risk of cancer is positively correlated between age, and also closely related to cysts types. Cancer are commonly found in type I and type IV cyst, whereas very rare in type II and type III patients. Total cyst resection+Roux-en-Y bile duct jejunum anastomosis is the gold standard for treatment of Choledochal cysts.In1987, French doctor Philippe Mouret completed the world’s first television laparoscopic cholecystectomy, as laparoscopic surgery has a small surgical trauma, less intraoperative bleeding, quick recovery, shorter hospitalization time, lighter postoperative pain, beautiful incision for a characteristic, make surgical gallbladder surgery a revolutionary progress, and promoting other laparoscopic surgical field, such as an appendectomy, hernia repair and gastric resection, and so on.In1995, Farello first report on laparoscopic common bile duct cyst resection and bile duct jejunum anastomosis, laparoscopic surgery has applied to the treatment of congenital bile duct cysts.Laparoscopic common bile duct cyst resection has a number of technical problems, the cyst resection is difficult, such as inflammation adhesion around cyst serious will increase the risk of hepatic artery, portal vein damage, and increases the incidence of postoperative wound bleeding, if the cyst under section is the pancreas packages, in the separation process it’s easy to damage the pancreatic duct, lead to pancreatic leakage after; Digestive tract reconstruction is difficult at the same time, the common bile duct jejunum anastomosis high technical difficulty, and prone to anastomotic leakage, anastomotic stenosis and postoperative complications, and laparoscopic surgery in the treatment of congenital bile duct cysts so far failed to gain popularity.Sir Run Run Shaw Hospital affiliated to zhejiang university, general surgery, attaches great importance to laparoscopic surgery, in the domestic first launched laparoscopic resection of pancreatic body tail, laparoscopic preserved spleen resection of pancreatic body tail, Laparoscopic radical prostatectomy for gastric carcinoma,such as a variety of advanced laparoscopic surgery, accumulated a large number of laparoscopic anatomical separation, the digestive tract reconstruction experience, and since2012the first laparoscopic common bile duct cyst excision plus Roux en-Y bile duct jejunum anastomosis was carried out, we have successfully completed8cases of laparoscopic common bile duct cyst surgery.Objectives:Analysis8cases of laparoscopic adult congenital bile duct cysts resection of data, discusses the feasibility and security of laparoscopic surgery for adult congenital bile duct cysts, summed up experience of laparoscopic surgery in the treatment of congenital bile duct cysts, and compared with open surgery, analysis the advantages and disadvantages in the treatment of congenital bile duct cysts.Method:Sir Run Run Shaw Hospital affiliated to zhejiang university school of medicine, general surgery, during February2008to February2014, a total of adult patients with congenital bile duct cysts treated34cases,24of whom underwent conventional laparotomy group (Open Group),8underwent laparoscopic common bile duct cyst resection+Roux en-Y bile duct jejunum anastomosis (Laparoscopic group), the other2cases were ruled out without surgery.32cases of patients with male to female ratio was1:3, the average age is35years old.The clinical data of32cases with this, auxiliary examination and surgical results of comparative analysis, explore the laparoscopic surgery in the treatment of adult congenital bile duct cysts of feasibility and safety, and compare the advantages and disadvantages between the two groups.Results:The average operation time Laparoscopic group was281.25±71.15min, Open group was250.00±76.62min, there was no significant difference between the two groups (P=0.311). Intraoperative blood lossLaparoscopic group was significantly less than the Open group (93.75±49.55ml vs.237.50±156.21ml, P=0.017).CRP after thesurgery Laparoscopic group with an average of33.73±15.50mg/L, Open group was78.78±27.87mg/L, there exists significant difference between the two groups (P<0.001).Postoperative anal exhaust time Laparoscopic group with an average of2.63±0.92d, Open group was3.71±0.95d, Laparoscopic group was significantly shorter than the Open group (P=0.014). First time eat liquid Laparoscopic group was3.00±0.76d, Open group was5.08±1.53d, there exists significant difference between the two groups (P=0.001).The average hospitalization time Laparoscopic group was 7.00±1.07d, Open group was9.83±2.73d, Laparoscopic group was significantly shorter than the Open group (P=0.008). Overall complication rate of Laparoscopic group was25%, the Open group was37.5%, there was no significant difference between the two groups (P=0.425).Conclusion:Laparoscopic surgery for adult congenital bile duct cyst is safe and feasible, at the same time it has the advantages of intraoperative bleeding, less surgical trauma, fast recovery, shorter postoperative hospital stay compared with open surgery. |
PDF Full Text Request