摘要
目的:探讨反复胆管炎患儿行腹腔镜胆总管囊肿手术的技巧。方法:回顾分析2012年1月至2017年12月为27例反复发作胆管炎患儿行腹腔镜胆总管囊肿手术的临床资料。采用四孔法施术,在腹腔镜监视下将胆囊经右上腹Trocar提出行胆道造影,判断胆道及胰管情况,在腹腔镜监视下游离胆囊,直至胆囊管与胆总管汇合处,游离囊肿前壁,横断囊肿,继续向远端游离至胰胆管汇合处,囊肿型远端不处理,梭形远端夹闭,切除胆囊及囊肿。扩大脐部切口,行空肠空肠Roux-Y吻合,再将肠管送回腹腔,经结肠后拉至肝门下。用4-0可吸收缝线行胆管与空肠端侧吻合。结果:26例在腔镜下完成手术,1例中转开腹,手术时间平均(3.9±1.1) h,出血量平均(45±24) mL,术后平均住院(12.0±2.5) d。术后胆漏2例、出血2例,经保守治疗好转,术后随访6个月～2年,无逆行胆管炎、胆管狭窄、癌变等远期并发症发生。结论:反复胆管炎患儿行腹腔镜胆总管囊肿手术是安全、可行的治疗方法。
Objective:To explore the surgical skills of laparoscopic choledochal cyst resection in children with recurrent cholangitis.Methods:The clinical data of 27 children with recurrent cholangitis who underwent laparoscopic choledochal cyst surgery from Jan.2012 to Dec.2017 were retrospectively analyzed.Four-port laparoscopic operation was performed.Cholangiography was performed on the gallbladder through Trocar of right upper quadrant to judge the biliary and pancreatic ducts.The gallbladder was separated under laparoscopic surveillance until the junction of the cystic duct and the common bile duct,the anterior wall of the cyst was separated,and the cyst was transected.Then the cyst was separated till the junction of pancreatic and bile ducts,the distal part of the cyst type was not treated,while the distal end of fusiform type was closed.The gallbladder and cyst was excised.The umbilical incision was enlarged and jejunojejunal Roux-Y anastomosis was performed.Then the intestinal tube was sent back to the abdominal cavity and pulled under the hepatic hilum through the colon.End-to-side anastomosis of bile duct and jejunum was performed with 4-0 absorbable suture.Results:Laparoscopic surgery was successful in 26 cases,1 case was converted to laparotomy.The average operation time was(3.9±1.1)h,the average amount of bleeding was(45±24)mL,and the average hospital stay was(12.0±2.5)d.There were 2 cases of bile leakage and 2 cases of bleeding after operation,which were improved after conservative treatment.The follow-up period ranged from 6 months to 2 years.No long-term complications such as retrograde cholangitis,bile duct stenosis or canceration occurred.Conclusions:Laparoscopic choledochal cyst surgery in children with recurrent cholangitis is a safe and feasible treatment.
作者
周立军
李功俊
沈刚
简闯
ZHOU Li-jun;LI Gong-jun;SHEN Gang(The Second Department of Surgery,Children's Hospital of Dalian Medical University,Dalian 116012,China)
出处
《腹腔镜外科杂志》
2018年第12期895-897,共3页
Journal of Laparoscopic Surgery
