Does pneumoperitoneum adversely affect growth, development and liver function in biliary atresia patients after laparoscopic portoenterostomy?

作者：Nakamura Hiroki; Koga Hiroyuki; Okazaki Tadaharu; Urao Masahiko; Miyano Go; Okawada Manabu; Doi Takashi; Watayo Hiroko; Ogasawara Yuki; Lane Geoffrey J; Yamataka Atsuyuki^*

来源：Pediatric Surgery International, 2015, 31(1): 45-51.

DOI：10.1007/s00383-014-3625-4

• Biliary atresia
• Development
• Growth
• Liver function
• Pneumoperitoneum
• Laparoscopic portoenterostomy

We assessed the effect of high partial pressure of arterial carbon dioxide (PaCO2) due to pneumoperitoneum (PP) on growth (height/weight) and development (gross/fine motor function, receptive/expressive communication, and social interaction), by comparing outcome after portoenterostomy (PE) for biliary atresia (BA) using laparoscopic PE (LPE: n = 13) and open PE (OPE: n = 13) cases performed between 2005 and 2014.
Our PE is based on Kasai's original PE. All data were collated prospectively.
Differences in duration of follow-up (LPE: 38.8 months; OPE: 38.1 months), jaundice clearance (LPE: 12/13 = 92.3 %; OPE: 9/13 = 69.2 %), survival with the native liver (LPE: 10/13 = 76.9 %; OPE: 9/13 = 69.2 %), incidence of cholangitis, hypersplenism, and incidence of esophageal varices were not significant. Mean intraoperative PaCO2 was significantly higher in LPE (LPE: 50.1 mmHg; OPE: 40.7 mmHg, p < 0.05). Liver function impairment was not statistically different, although LPE results were slightly worse. There was no overall delay in growth observed, although height/weight gain was more consistent in LPE. The pattern of developmental delay observed was similar for LPE and OPE suggesting that developmental delay is not PE-related; in other words, PP is not implicated in developmental delay.
PP during LPE would appear to have no adverse effects on overall growth/development and liver function in BA patients.

• 出版日期2015-1