背景:胆总管囊肿是罕见的先天性胆管囊性扩张。美国的发病率在每100万人中5到15例之间变化。相比之下,亚洲人,这是夏威夷人口的很大一部分,发病率约为每1000个新生儿中的一个。我们报告了机器人辅助腹腔镜手术治疗胆总管囊肿的胆道重建的经验,这是迄今为止美国报道的最大病例系列。
方法:对2006年至2021年在三级儿童医院诊断为胆总管囊肿的患者进行回顾性分析。进行围手术期分析。并发症被定义为立即,早期,或迟到。数据进行了简单的描述性统计。
结果:19例患者接受了胆总管膀胱切除术和肝十二指肠造口术。十三人接受了机器人方法,其余的则计划进行腹腔镜检查。19人中有18名是女性,亚洲血统为15/19。年龄从5个月到21岁不等。提出诊断包括黄疸,原发性腹痛,胰腺炎,和胆管炎.68%有1型梭形囊肿,其余为4a型。机器人与腹腔镜的手术时间和住院时间分别为321对267分钟和8.2对17.3天,分别。对于机器人组,有1例直接并发症是由腹膜炎引起的.一年的随访显示,两名患者需要内窥镜逆行胰胆管造影术并扩张/支架置入吻合口狭窄。没有吻合口泄漏。
结论:机器人辅助腹腔镜胆总管囊肿切除术联合肝十二指肠造口术与总体良好的预后相关,最常见的长期并发症是吻合口狭窄。
Choledochal cysts are rare congenital biliary cystic dilations. The US incidence rate varies between 5 and 15 cases per 1,000,000 people. In contrast, Asians, which are a large subset of the population of Hawaii, have an incidence of approximately one in every 1000 births. We report our experience with robot-assisted laparoscopic surgical management with biliary reconstruction of choledochal cysts which to date is the largest American
case series to be reported.
From 2006 to 2021, patients diagnosed with a choledochal cyst(s) at a tertiary children\'s hospital were retrospectively reviewed. Perioperative analysis was performed. Complications were defined as immediate, early, or late. The data underwent simple descriptive statistics.
Nineteen patients underwent choledochal cystectomy and hepaticoduodenostomy. Thirteen underwent a robotic approach while the rest were planned laparoscopic. Eighteen of 19 were female with 15/19 of Asian descent. The ages ranged from 5 mo to 21 y. Presenting diagnoses included jaundice, primary abdominal pain, pancreatitis, and cholangitis. Sixty eight percent had type 1 fusiform cysts while the rest were type 4a. Operative time and length of stay for robotic versus laparoscopic were 321 versus 267 min and 8.2 versus 17.3 d, respectively. For the robotic group, there was one immediate complication due to peritonitis. One-year follow-up revealed two patients requiring endoscopic retrograde cholangiopancreatography with dilation/stenting for an anastomotic stricture. There were no anastomotic leaks.
Robot-assisted laparoscopic choledochal cystectomy with hepaticoduodenostomy is associated with overall good outcomes with the most common long-term complication being anastomotic stenosis.