摘要
目的胆总管囊肿切除术中，远端胆总管残端需要游离和结扎，但游离和结扎存胰管有损伤的风险，甚至导致胰漏的发生。本研究旨在探讨囊肿型胆总管囊肿切除术中不结扎远端残端的可行性，从而减少术中胰腺实质损伤的风险。方法将我院2001年10月至2010年10月实施胆总管囊肿切除术和Roux-en-Y肝管空肠吻合术的270例患儿，根据胆总管囊肿不同的影像学和形态学特点分成两组：①不结扎组（n=207），即远端残端狭窄，选择不结扎远端残端术式；②结扎组（n=63），即远端残端无狭窄，选择结扎远端残端术式。对比分析两组术后胰漏发生率。结果不结扎组和结扎组分别随访36个月和33个月，两组均未发现胰漏。结论在远端胆总管狭窄类型（囊肿型）的胆总管囊肿切除术中不结扎远端残端是可行的，减少了胰管受损的可能，对避免胰漏发生起到了一定的作用，同时简化了手术步骤，值得在临床中推广应用。
Objective After excision of choledochal cysts （CDC）, the distal common bile duct （CBD） stumps are conventionally ligated. Yet, the distal common bile duct stump mobilization and ligation carries certain risk of pancreatic duct injury. The current study investigates the feasibility of selectively leaving distal stump unligated in CDC children with stenotic distal CBD. Methods Between 21）01 and 2010, 270 CDC children successfully underwent laparoscopic cyst excision and Roux-en-Y hepatojejunostomy and were recruited into this study. The distal stump management was based on its radiological morphology. The patients were divided into two groups： ①nonqigation group （n = 207）, where the distal stump was stenotic and was left unligated; ②ligation group （n = 63）, where the distal stump was not stenotic and was ligated. The pancreatic juice leakage rates were compared. Results The median follow-up periods in the non-ligation and ligation group were 36 and 33 months, respec- tively. There was no pancreatic juice leakage in either group. Conclusions Not ligating distal stump is a feasible approach for managing CDC with stenotic distal CBD. It simplifies the operative procedure and may minimize pancreatic duct injury.
出处
《中华小儿外科杂志》
CSCD
北大核心
2012年第11期820-822,共3页
Chinese Journal of Pediatric Surgery
关键词
胆总管囊肿
胰胆管合流异常
胰管损伤
Choledochal cyst
Pancreaticobiliary malunion
Pancreatic duct injury
