腹腔镜下胆总管囊肿切除、胆道重建术  

Laparoscope assisted resection of choledochal cyst and biliary reconstruction

作　　者：李索林[1] 时保军[1] 温哲[1] 于增文[1] 李振东[1] 

机构地区：[1]河北医科大学第二医院小儿外科,石家庄050000

出　　处：《中华小儿外科杂志》2004年第4期298-301,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的　探讨腹腔镜下胆总管囊肿根治切除、胆道重建术的可行性。方法　腹腔镜辅助下胆囊或胆总管穿刺胆道造影 ,同时镜下行胆总管囊肿切除及肝管空肠Roux Y吻合术。结果　 13例胆道造影显示均伴有胆胰管合流异常。 7例胆总管呈囊状扩张 (6例KomiⅠa型、1例KomiⅠb型 ) ;5例胆总管呈梭形扩张 (2例KomiⅡa型、3例KomiⅡb型 ) ;1例胆总管远段胰腺内囊肿中转开腹手术。 12例腹腔镜下顺利根治切除胆总管囊肿 ,4例经结肠后、8例经结肠前吻合胆道重建术 ,手术时间 4 .2～ 6 .5h。结论　腹腔镜下胆道造影方法简便、诊断明确 ;胆总管囊肿根治切除及胆道重建手术安全可靠 。Objective To study feasibility of using laparoscopic technique to perform intraoperative cholangiography, complete resection of choledochal cyst with biliary reconstruction. Methods Under the guidance of laparoscope, the intraoperative cholangiography was carried out with a long needle puncturing into the gallbladder or choledochal cyst. The total excision of the cyst and Roux en Y hepaticojejunostomy were then performed. Results Thirteen cases were all diagnosed with anomalous junction of pancreaticobiliary duct (APBD) by the cholangiopancreatography. The choledochus was shown cystic dilatation in 7 of them (6 with type Ia and 1 with type Ib according to Komi classification). In the other 5, the biliary tract was found to be fusiform dilatation (Komi Ⅱ). An intrapancreatic choledochocele was confirmed in one and the open surgery was needed. The procedure was successfully accomplished in all 12 patients. The retrocolic hepatiojejunal anastomoses was completed in 4 cases and the anterocolic anatomoses in the other 8. The duration of the procedures ranged from 4.2 to 6.5 hours. Conclusions Laparoscopically assisted cholangiography is a simple and valuable diagnostic method for choledochal cyst with APBD. Resection of the choledochal cyst with hepaticojejunostomy using laparoscope is technically feasible and safe procedure, and deserves further clinical trials.

关 键 词：腹腔镜 胆总管囊肿 囊肿切除术 胆道重建术 外科学 胆管造影术 

分 类 号：R726.5[医药卫生—儿科]