完全腹腔镜胆总管切除肝总管空肠Roux-Y吻合术五例经验  

Total laparoscopic choledochus resection with Roux-Y hepatoenterostomy:report of 5 cases

作　　者：王存川[1] 徐安安[1] 胡友主[1] 李进义[1] 杨景哥[1] 许朋[1] 

机构地区：[1]暨南大学附属第一医院普通外科,广州510630

出　　处：《中华腔镜外科杂志（电子版）》2009年第1期20-22,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨完全腹腔镜胆总管切除肝总管空肠Roux-Y吻合术的方法和优缺点。方法2003年4月至2004年11月,5例患者接受了完全腹腔镜胆总管切除肝总管空肠Roux-Y吻合术,其中先天性胆总管囊肿4例,胆总管中段癌1例。结果4例顺利完成手术,出血10～150ml,手术时间255(220～300)min,1例同时行疝囊高位结扎术。3例放置了胆道支架管,术后40～50d拔出。术后平均住院时间10d。1例有疤痕体质患者因术后轻微胆瘘给予保守治疗,停留肝下引流管21d后痊愈出院,并于术后4个月因肝肠吻合口狭窄行腹腔镜吻合口狭窄松解成型术,余3例患者术后已经随访21～35个月,无复发等并发症发生,情况良好(胆管癌术后已生存35个月)。1例2岁小儿患者术中分离胆总管囊肿后壁时出血中转为开腹手术。结论经过选择的患者进行腹腔镜胆总管切除肝总管空肠Roux-Y吻合术技术上是可行的,具有微创、恢复快,术后腹壁疤痕小、腹腔粘连少等优点,值得进一步探讨。Objective to describe a technique of total laparoscopic choledochus resection with Roux-Y hepatoenterostomy.Methods 4 patients of choledochocele and 1 patient of carcinoma of gallbladder received total laparoscopic choledochus resection from April,2003 to November,2004.1 case is man,4 cases are women.The age were 2-71.Results 4 cases successfully underwent laparoscopy.The operative time ranged from 220 to 300 min.The hemorrhage were 10-150 ml in operation.1 case was given laparoscopic hernia high ligation at the same time.The average hospital stay was 10 days.1 case was infection of biliary tree after operation,recovered after 21 days,and laparoscopic stenostomia solution Postoperative follow-up were 21-35 months in 3 cases.1 case was transformed to open operation because of hemorrhage.Conclusions Tota laparoscopic choledochus resection with Roux-Y hepatoenterostomy is a safety and effectively minimal invasive operation for those chosen patients.The key of success is operation careful and avoiding hemorrhea.

关 键 词：腹腔镜 胆总管切除术 胆总管囊肿 胆管癌 手术 ROUX-Y 

分 类 号：R657.4[医药卫生—外科学]