恶性梗阻性黄疸的腹腔镜姑息性手术治疗—单中心9例病例总结和文献回顾  

Laparoscopic papillative surgery for malignant obstructive jaundice:a single center experience of 9 cases with literature review

作　　者：田雨[1] 吴硕东[2] 

机构地区：[1]中国医科大学附属盛京医院第一微创外科,辽宁沈阳110004 [2]中国医科大学附属盛京医院胆道外科,辽宁沈阳110004

出　　处：《现代肿瘤医学》2009年第5期875-877,共3页Journal of Modern Oncology

基　　金：辽宁省科学计划项目(编号:2005225007)

摘　　要：目的:报告9例恶性梗阻性黄疸的腹腔镜姑息性手术治疗经验,并回顾总结近年相关文献。方法:收集2004年5月至2008年4月入院行姑息性腹腔镜手术治疗的9例恶性梗阻性黄疸病人的临床资料并分析,检索并回顾总结近年相关文献。结果:9例恶性梗阻性黄疸病人中,壶腹部癌3例,胰头癌2例,胆管癌4例;2例中转开腹,1例为难以控制的出血,1例为高碳酸血症;腹腔镜下完成的术式包括胆囊空肠吻合术4例,胆肠吻合口手工缝合2例,机械缝合2例,平均手术时间115min;平均失血量56.3ml,无术后并发症发生;术后平均住院时间4.8天;围手术期死亡率0。胆总管空肠Roux-en-Y吻合术3例,胆肠吻合口手工缝合1例,机械缝合2例,平均手术时间180min;平均失血量150ml;术后并发症:自限性胆汁瘘1例;术后平均住院时间10天;围手术期死亡率0。结论:腹腔镜胆肠内引流术创伤小、恢复快,是不能根治切除的恶性梗阻性黄疸姑息治疗的安全、有效和可行的选择。Objective：To report our experience of laparoscopic papillative surgery for malignant obstructive jaundice in a consecutive series of 9 patients with recent years of literature review. Methods： From May 2004 to April 2008,9 patients with malignant obstructive jaundice underwent laparoscopic papillative operations. Clinical data was collected and analyzed, and recent years literatures were reviewed. Results：Nine cases of malignant obstuctive jaundice underwent papillative laparoscopic cholecystojejunostomy and choledochojejunostomy. Among them,3 cases were suffered from ampullary carcinoma,2 cases were pancreas cancer,and 4 cases were bile duce malignancies. In 2 patient, conversion to open surgery was required because of severe hyperearbia or hemorrage. For 4 cases of cholecystojejunostomy,2 cases were hand - only sutured,and 2 cases were mechanical sutured. The mean operating time was 115 minutes, and the mean blood loss was 56.3 ml. No complications were observed in all cases. The mean hospital stay was 4.8 days, and perioperative mortality was 0. For 3 cases of choledochojejunostomy, one case was hand - only sutured,and 2 cases were mechanical sutured. The mean operating time was 180 minutes, and the mean blood loss was 150 ml. Self - limited biliary fistula was observed in one case. The mean hospital stay was 10 days, and perioperative mortality was 0. Conclusion： Laparoscopic papillation for malignant obstructive jaundice is safe, feasible, and effective.

关 键 词：腹腔镜 姑息性手术 梗阻性黄疸 恶性 

分 类 号：R730.6[医药卫生—肿瘤] R730.56[医药卫生—临床医学]