摘要
目的 对经腹腔镜行先天性胆总管囊肿切除 ,肝管空肠Roux Y吻合术的关键技术进行探讨。方法 采用四Trocar技术首先行腹腔镜监视下胆道造影后切除胆囊 ,然后用超声刀游离胆总管囊肿前壁 ,切开囊肿前壁后 ,横断囊肿 ,向近端游离至胆总管与肝总管的交界处 ,向远端游离至囊肿与胰管的汇合处 ,彻底切除囊肿壁。经脐部 2cm切口提出距Treitz韧带 2 0cm处空肠于腹壁外 ,行空肠空肠Roux Y吻合 ,保留肝支 30～ 35cm ,然后将肠管送回腹腔经结肠后拉至肝门下。用 5 0可吸收缝线将肝管与空肠端侧吻合。结果 本组 8例患儿手术全部成功。手术时间平均为 4 8h(3 6～6h) ,出血量 10～ 5 0ml,吻合口直径 1 0～ 1 5cm ,术后平均住院时间 4 5d(3～ 8d)。术后随访 1～ 6个月 ,未发现逆行感染 ,肠粘连梗阻和吻合口狭窄发生。结论 经腹腔镜行先天性胆总管囊肿切除 。
Objective The aim of this study was to discuss the technical details on laparoscopic total cyst excision with Roux Y hepatoenterostomy for the treatment of choledochal cyst in children.Methods Eight patients with type Ⅰ choledochal cyst (median age 3 6 years) underwent laparoscopic cyst excision with Roux Y hepatoenterostomy from July 2001 to April 2002.Under laparoscopic guidance, intraoperative cholangiogram was performed, the gallbladder and the dilated bile duct were completely excised. Roux en Y jejunojejunostomy was performed extracorporeally through umbilical incision (2 cm), and an end to side anastomosis was carried out intracorporeally.Results Median duration of operation was 4 8 hours (3 6 to 6 0 hours), intraoperative bleeding was between 10 to 50 ml. Hospital stay after the operation ranged from 3 to 8 days. There was no intra or postoperative complication.ConclusionLaparoscopic total cyst excision with Roux Y hepatoenterostomy was effective and safe procedure for children with choledochal cyst.
出处
《中华普通外科杂志》
CSCD
北大核心
2002年第8期473-475,共3页
Chinese Journal of General Surgery
