胆总管囊肿伴肝总管狭窄患儿的腹腔镜手术治疗  

Laparoscopic surgery for congenital choledochal cyst with stenosis of common hepatic duct in children patients

作　　者：李爱武[1] 宋亚宁[2] 席栋[1] 王建[1] 张强业[1] 张文同[1] 崔新海[1] 李龙[3] 

机构地区：[1]山东大学齐鲁医院小儿外科,济南250012 [2]山东潍坊市中医院 [3]首都儿科研究所

出　　处：《中华腔镜外科杂志（电子版）》2010年第3期25-27,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜手术治疗胆总管囊肿伴有肝总管狭窄患儿的治疗方法。方法自2007年1月至2009年12月,共收治胆总管囊肿患儿41例,其中7例伴有肝总管狭窄的患儿均在腹腔镜下完成手术。采用四孔Trocars技术,先在腹腔镜下游离胆囊并将其提出腹壁外,行38%泛影葡胺造影,判断胆总管囊肿及肝总管的情况;电凝钩或超声刀游离切除囊肿;于脐孔处提出空肠行端侧吻合术;腹腔镜探查近端肝总管情况,将狭窄肝总管前壁向近端游离、切开、成形,并探查肝内胆管;行镜下胆肠端侧吻合术。结果 7例胆总管囊肿伴有肝总管狭窄的患儿均在腹腔镜下完成手术,术中造影及腔镜探查证实囊肿近端肝总管狭窄,直径1～2mm,长度2mm左右,切开狭窄肝总管前壁至宽敞部,3例伴有肝总管结石,1例伴有蛋白栓,均游离近端肝总管行肝肠吻合。术后黄染、腹疼等症状消失,随访6个月至2年均无胆系感染或胆道梗阻发生。结论胆总管囊肿伴有肝总管狭窄的患儿在腹腔镜下行狭窄肝总管切开成形、胆肠吻合术,比开放性手术更容易操作,预后好,能够预防胆道梗阻及胆管炎的发生。Objective To study the effects of laparoscopic surgery on congenital choledochal cyst with stenosis of common hepatic duct in children patients. Methods Forty-one children patients with congenital choledochal cyst were cured from April 2001 to March 2007, including 7 cases with stenosis of common hepatic duct who underwent laparoscopic cyst excision. Four trocars were used for cholecystography with 38% diatrizoate meglumine and total resection of the gallbladder and choledochal cyst. The incision at the umbilicus was enlarged for Roux-en-Y anastomosis. The stenosis of common hepatic duct was then identified by laparoscopy. The anterior wall of stenosis was dissected and reconstructed, and then the anastomosis between proximal hepatic duct and the Roux-en-Y limb was performed. Results Laparoscopic surgery was accomplished in all of the 7 cases. The stenosis of common hepatic duct was confirmed by cholecystography and laparoscopy with 1-2 mm in diameter and 2 mm in length. After the dissection of stenosis, calculus was observed in 3 cases and embolus in 1 case. Proximal hepatic duct was used for the anastomosis. Choleplania and abdominalgia were recovered postoperatively. All cases were followed-up for 6 to 48 months and no patient was suffered from biliary inflammation and obstruction. Conclusions Compared to open surgery, laparoscopic surgery has many advantageous and can prevent biliary inflammation and obstruction. It is a better treatment for congenital choledochal cyst with stenosis of common hepatic duct in Children Patients.

关 键 词：胆总管囊肿 肝总管狭窄 腹腔镜手术 

分 类 号：R726.5[医药卫生—儿科]