腹腔镜在先天性胆管扩张症中的应用  

Laparoscopic surgery for congenital biliary dilatation

作　　者：李索林[1] 王文博[1] 牛忠[2] 于增文[1] 许书清[2] 李英超[1] 徐伟立[1] 耿娜[1] 李萌[1] 

机构地区：[1]河北医科大学第二医院,河北石家庄050000 [2]邢台市人民医院

出　　处：《腹腔镜外科杂志》2011年第7期491-495,共5页Journal of Laparoscopic Surgery

基　　金：国家十一五科技支撑项目(编号:2006BAI05A06)

摘　　要：目的：总结腹腔镜手术诊治先天性胆管扩张症（congenital biliary dilatation,CBD）的经验,评价腹腔镜肝外扩张胆管切除、肝管空肠吻合术的可行性及安全性。方法：回顾2002~2010年腹腔镜手术治疗106例CBD患者的临床资料,分析其手术技术、围手术期并发症及随访情况。结果：62例胆总管呈囊状扩张、44例呈梭形扩张。其中,83例行术中胆道造影,77例显示胰胆管合流异常。103例成功完成腹腔镜手术,3例中转开腹,其中1例囊肿巨大,1例Ⅲ型囊肿损伤十二指肠,1例合并炎性血管瘤出血。24例伴有肝内胆管局限性扩张（IV-A型）同时行肝门胆管狭窄段切开或切除扩大成形术。手术时间平均（214.9±58.3）min,术后平均住院（7.7±2.3）d。围手术期发生并发症8例,1例术中门静脉损伤,5例暂时性胆漏,1例胆支空肠袢扭转,1例应激性溃疡。随访6个月~8年,1例发生肝门吻合口狭窄行二次手术解除,1例术后切口疝经手术修复,2例肠梗阻经保守治疗后缓解。余者恢复良好。结论：腹腔镜术中胆胰管造影可确定CBD类型及胆胰管合流情况,腹腔镜提供的视野放大效果有助于根除病变、避免损伤胆胰管连接部和矫治肝门胆管狭窄,腹腔镜手术可安全地施行并取得满意效果。Objective：To summarize the experiences of laparoscopic surgery for congenital biliary dilatation（CBD）,and evaluate the feasibility and safety of laparoscopic excision of dilated extrahepatic duct and hepatojejunostomy.Methods：The clinical data of 106 patients with CBD underwent laparoscopic procedure were retrospectively reviewed from 2002 to 2010.The surgical techniques,perioperative complications and follow-up problems were analyzed.Results：Of them,62 cases manifested choledochal cystic dilation and 44 cases fusiform dilation.An intraoperative cholangiography was performed in 83 cases,and a pancreaticobiliary maljunction（PBM） was confirmed in 77 cases.Laparoscopic procedure was performed successfully in 103 cases.Conversion was taken in three cases due to dissecting on the giant cyst hardly（1）,duodenum injury in type Ⅲ cyst（1） and inflammatory hemangioma bleeding（1）.There were 24 patients with type IV-A cysts,their stenotic segments were splited or excised and a wide ductoplasty was completed at the porta hepatis.The mean operative time was（214.9±58.3） min,and the average postoperative hospital stay was（7.7±2.3） d.Perioperative complications were observed in 8 cases,including 1 case of portal vein injury,5 cases of temporary bile leakage,1 case of a torsion of the jejunal Roux loop and 1 case of stress ulcer.During the following 6 months to 8 years,4 patients developed surgical problems including hepaticojejunal anastomotic stricture（1）,a port herniation（1） and bowel ileus（2）.The others recovered well.Conclusions：Laparoscopic intraoperative cholangiography can identify the CBD variations and PBM coexists.With the magnified laparoscopic view,it can help to eradicate the abnormalities,avoid the pancreatobiliary union injury and correct intrahepatic biliary strictures.Laparoscopic surgery can be safely applied in CBD with satisfactory results.

关 键 词：先天性胆管扩张症 腹腔镜检查 胆管肠吻合术 肝 

分 类 号：R657.4[医药卫生—外科学]