腹腔镜胆总管囊肿根治切除、肝管空肠吻合术  

Laparoscopic radical resection for congenital choledochal cyst and Roux-en-Y hepaticojejunostomy

作　　者：李索林[1] 李英超[1] 耿娜[1] 于增文[1] 李萌[1] 李振东[1] 

机构地区：[1]河北医科大学第二医院,河北石家庄050000

出　　处：《腹腔镜外科杂志》2007年第2期147-149,共3页Journal of Laparoscopic Surgery

摘　　要：目的：探讨腹腔镜下胆道造影和胆总管囊肿根治切除、肝管空肠吻合术的可行性。方法：34例先天性胆总管囊肿患者行腹腔镜下胆道造影，胆囊和囊状胆管完全切除，经脐孔提出空肠行Roux-en-Y吻合和体内肝管空肠吻合手术。结果：胆道造影显示胆管囊状扩张24例，梭形扩张10例。33例腹腔镜下顺利完成手术，手术时间平均4．2h（3．5～6．5h）；1例胰腺内胆总管远段囊肿中转开腹手术。4例合并肝管狭窄同时行胆管成形术。术后5～7d患者痊愈出院。31例获得随访，5～40个月未发生术后并发症。结论：腹腔镜下胆道造影简便实用，对指导镜下根治切除囊肿，避免损伤胆胰管连接部和处理肝内胆管狭窄有重要参考价值。Objective：To explore the feasibility of intraoperative cholangiography and radical resection of choledochal cyst with hepaticojejunostomy by laparoscopy. Methods：Under laparoscopic guidance, 34 cases of congenital choledochal cyst undergone an intra- operative cholangiography ,the gallbladder and the cystic choledochus were excised completely, Roux-en-Y anastomosis was constructed after exteriorization of the jejunum via the umbilical trocar incision. After repositioning of the bowel an end-to-side hepaticojejunostomy was carried out intracorporeally by the hand suture. Results ：There were 24 cystic and 10 fusiform dilatations according to cholangiography. These procedures were performed in 33 patients without intraoperative events with a median duration of 4.2 hours（ range from 3.5 to 6.5 hours）. One conversion was necessitated due to intrapancreatic choledochocele. 4 cases with intrahepatic ductal stenoses underwent the duct plasty concomitantly. Hospitalization ranged from 5 to 7 days after the procedure. There was no postoperative complication during a follow up period from 5 to 40 months. Conclusions：Laparoscopic cholangiography is a simple and valuable method,which can directe laparoscopic resection of total choledochal cysts,to prevent the union injury and treat stenosis of the intrahepatic bile ducts.

关 键 词：胆总管囊肿 胆道造影 腹腔镜术 

分 类 号：R657.4[医药卫生—外科学]