外固定肝脏拉钩在腹腔镜下胆总管囊肿切除和胆道重建术中的应用  

Laparoscopic Resection of Choledochal Cyst Combined with Roux-en-Y Hepaticojejunostomy with Nathanson Liver Retractor in Children

作　　者：刘继炎[1] 李涛[1] 姜斌[1] 周勇[1] 孙斌[1] 王浩[1] 周建峰[1] 杜宝峰[1] 刘大林[1] 易军[1] 

机构地区：[1]南京医科大学附属南京儿童医院外科,南京210008

出　　处：《中国微创外科杂志》2010年第3期250-251,255,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨外固定肝脏拉钩在腹腔镜下胆总管囊肿切除和胆道重建术的应用价值。方法采用四孔加外置入Nathanson肝脏拉钩外固定技术,腹腔镜下行胆总管囊肿切除、Roux-en-Y胆道重建术。结果20例患儿手术全部成功,无中转开腹手术,无死亡。1例合并美克尔憩室,经脐部拔出后切除;3例患儿应家长要求同时切除阑尾。手术时间3～5.5h(平均3.5h);术中出血量10～30ml。1例胆漏。术后住院时间6～9d(平均6d)。20例术后随访3～30个月(平均14个月),无肠粘连梗阻和吻合口狭窄发生。结论利用外固定肝脏拉钩的牵引可以扩大腹腔空间,便于腹腔镜下操作。Objective To introduce our experience on the use of Nathanson liver retractor.Methods We performed laparoscopic excision and Roux-en-Y hepaticojejunostomy of the choledochal cyst with Nathanson liver retractor in 20 patients aged from 6 months to 12 years（average age,5.5 years）.In the series,Nathanson liver retractor and four Trocar ports were used.ResultsLaparoscopic excision was successfully performed in all the patients.No patient died or was converted to laparotomy.The operation time ranged from 3 to 5.5 hours with a mean of 3.5 hours,and the mean blood loss during the procedure was 10-30 ml.Meckel＇s diverticulums were found and removed during the operation in one case,and appendectormy was performed on three children as requested by their parents.After the surgery,bile leakage was observed in one case.The average postoperative hospital stay in our patients was 6.5 days（ranged from 6 to 9 days）.Twenty of the patients achieved a follow-up for 3-30 months（mean,14 months）,during which no episodes of cholangitis,adhesive ileus or anastomotic stoma stricture occurred.Conclusions Using Nathanson liver retractor to expose the abdominal cavity providing a good view is convenient for safe laparoscopic operative performance.

关 键 词：腹腔镜 胆总管囊肿 Nathanson肝脏拉钩 

分 类 号：R657.4[医药卫生—外科学]