摘要
目的 本研究对腹腔镜先天性胆总管囊肿切除 ,肝管空肠Roux Y吻合术进行探讨。方法 从 2 0 0 1年 6月至 2 0 0 3年 9月 ,共收治先天性胆总管囊肿患儿 4 5例 ,年龄 2个月到 12岁。其中 4 2例为囊肿型 ,平均囊肿直径 3.8cm(2～ 18cm) ;其余 3例为梭形 ,直径分别为 1.5、2 .0和 2 .2cm。本组 4 5例患儿均经腹腔镜行先天性胆总管囊肿切除 ,肝管空肠Roux Y吻合术。结果 本组 4 5例患儿手术全部成功 ,手术时间平均为 4 .3h(3.5～ 7.6h) ,术中出血量约 5～ 10ml。本组 8例患儿合并肝管狭窄 ,术中同时行腹腔镜胆总管囊肿切除及肝管成形 ;6例患儿合并共同管内蛋白栓 ,术中通过腹腔镜导入肠道或插管冲洗清除。其中 1例患儿于术后第 1d发生胆漏 ,术后第 2 6d时自愈 ;其余 4 4例患儿术后恢复顺利 ,住院时间 3～ 6d。术后随访 3～ 30个月 ,无肠粘连梗阻和吻合口狭窄等术后并发症发生。结论 经腹腔镜先天性胆总管囊肿切除 ,肝管空肠吻合术是一种安全可靠的方法 ,术中胆道造影全面了解胆道的结构 ,清晰的肝门暴露 ,准确的囊肿分离和熟练的缝合技术是手术成功的关键。
Objective To describe the procedure and outcome of laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy for choledochal cyst in children. Methods Forty-five patients with choledochal cyst underwent laparoscopic cyst excision with Roux-en-Y hepatoenterostomy between July 2001 and September 2003. Their ages ranged from 2 months to 12 years （average, 3.6 years）. The choledochal cysts were cyst type in 42 cases with the average diameter of 3. 8 cm （from 2. 5 to 18 cm） and fusiform type in the other three cases with the diameter of 1.5,2. 0 and 2.2 crn. Four trocars were utilized with 3 to 5 mm instrumentation. Under laparoscopic guidance intraoperative cholangiography was performed, the gallbladder and the dilated bile duct were completely excised. By using laparoscopic lens as the intraoperative endoscopy, the intrahepatic bile ducts and the common channel of the pancreaticobiliary junction were examined for stone debris and ductal stenosis. To reduce the duration of pneumoperitoneum, a Roux-en-Y hepatoenterostomy was divided into two stages： a Roux-en-Y jejunojejunal anastomosis was performed extracorporeally by exteriorizing the jejunum through the extending umbilical incision （1.5 to 2 cm）, and an end-to-side anastomosis was carried out intracorporeally by the continuous hand suture methods between the stump of the hepatic duct and the Roux-en-Y limb. This combination of the procedures was as safe and technically easy as conventional surgery. All of them were followed up from 3 to 30 moths. Results Average duration of operation was 4.3 hours （ranged from 3.5 to 7.6 hours）, intraoperative bleeding was 5 to 10 ml without necessity for blood transfusion. 8 of 45 patients were associated with hepatic ductal stenosis and underwent laparoscopic excision of the cyst and ductoplasty. In one of 8 cases, the bile leakage was noted from day 1 through 26 postoperatively. The postoperative course was uneventful in 44 of 45 patients with hospital stay ranged from 3 to 6 days after the operation. There was no postoperative complication during followed-up visits. Conclusions Laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy is feasible, safe and effective for the treatment of choledochal cyst in children.
出处
《中华小儿外科杂志》
CSCD
北大核心
2005年第1期20-23,共4页
Chinese Journal of Pediatric Surgery
关键词
胆总管囊肿
外科学
腹腔镜
Choledochal cyst
Surgical procedures, laparoscopic
