腹腔镜下胆总管囊肿切除、肝管空肠吻合、腹腔外空肠吻合术50例报告  

Resection of Congenital Choledochal Cyst,Hepaticojejunostomy,and Extra-Abdominal Roux-en-Y Anastomosis:Middle-term Results of 50 Cases

作　　者：汤绍涛[1] 王勇[1] 毛永忠[1] 童强松[1] 曹国庆[1] 杨瑛[1] 赵志祥[1] 

机构地区：[1]华中科技大学附属协和医院小儿外科,武汉430022

出　　处：《中国微创外科杂志》2009年第9期769-772,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜下胆总管囊肿根治切除、肝管空肠吻合、腹腔外空肠吻合术的技巧和中期疗效。方法对大的囊肿,于囊肿中部切开前壁,再用电钩横断囊肿后壁;对小的囊肿,围绕囊肿周围游离,完整切除扩张胆管。对反复发生胆管炎症的患儿,采用Lilly’s方法游离囊肿。脐部切口扩大至1.5 cm,将空肠提出腹壁外,行空肠Roux-Y吻合。腹腔镜监视下肝管空肠端侧吻合。结果16例患儿行囊肿全部切除,34例患儿行Lilly’s囊肿切除。1例早期手术患儿术前反复发作胆管炎症,囊肿周围紧密粘连,分离中渗血明显中转开腹完成手术。手术时间190-450 min,平均226 min。8例患儿需要输血。术后住院时间6-16 d,平均8 d。49例术后随访3-39个月,平均26个月。术后并发症4例：1例发生胆漏,经腹腔引流后自愈;急性胰腺炎1例,保守治疗治愈;肠粘连肠梗阻1例,保守治疗;肠坏死1例,开腹探查见空肠肝支肠管梗阻坏死,行肠切除和再次胆肠吻合手术。余45例无腹痛、发热、黄疸等症状。无胆管狭窄和反流性胃炎病例,无手术死亡。结论分离囊肿后壁,避免门静脉损伤是最关键的腹腔镜操作;胆肠吻合是腹腔镜最难的技术。腹腔镜下胆总管囊肿根治术疗效满意。Objective To assess the middle-term results of laparoscopy in resection of congenital choledochal cyst, hepaticojejunostomy, and extra-abdominal Roux-en-Y anastomosis. Methods We retrospectively studied 50 patients who had undergone laparoscopic choledochal cyst excision in our institute from 2005 to 2008. For large cysts, we dissected and separated the cyst at the middle portion, and then opened the inferior wall of the cyst to dissect the posterior wall of the cyst from the portal vein. For small cysts, we divided the cysts circumferentially and then completely excised the dilated bile duct. When the cyst was intensely inflamed, excision of the cysts was performed as Lilly＇ s technique. Roux-en-Y jejunojejunostomy was performed extracorporeally through an umbilical incision （ 1.5 cm） , afterwards, end-to-side anastomosis was carried out intracorporeally. The conversion to open surgery, and morbidity and mortality rates of the patients was analyzed. Results The cysts were completely excised in 16 cases, and Lilly＇ s technique was performed on 34 cases. One patient was converted to open surgery due to hemorrhage resulted from recurrent inflammatory-caused tight adhesion between the cyst and surrounding tissues. The mean operation time was 226 minutes （range： 190 to 450 minutes）. Eight patients received blood transfusion during the operation. The children were discharged from hospital in 6 to 16 days after the surgery （mean, 8 days）. A mean of 26 months follow-up was achieved in 49 patients （ranged 3 to 39 months）. Four patients developed complications： one of them showed bile leakage and then were cured by intra-abdominal drainage; one patient developed acute pancreatitis and one suffered from adhesive small bowel obstruction, both recovered after conservative treatment; intestinal necrosis was detected in one patient, who received another operation for resection of the necrotic bowel and anastomosis of the bile duct and intestine. In the other 45 patients, no abdominal pain, fever,jaundic

关 键 词：先天性胆总管囊肿 肝总管空场吻合术 腹腔镜 

分 类 号：R726.5[医药卫生—儿科]