小儿腹腔镜胆总管囊肿切除术45例  

Laparoscopic excision of congenital choledochal cyst in 45 cases

作　　者：卞红强[1] 段栩飞[1] 杨俊[1] 郑凯[1] 杨虎[1] 汪昕[1] 左楚清[1] 汤绍涛[2] 

机构地区：[1]武汉市妇女儿童医疗保健中心,湖北省武汉市430001 [2]武汉协和医院,湖北省武汉市430022

出　　处：《临床小儿外科杂志》2013年第1期25-27,共3页Journal of Clinical Pediatric Surgery

摘　　要：目的总结腹腔镜下小儿胆总管囊肿切除、肝总管空肠Roux-en-Y吻合术的经验。方法回顾性分析2010年1月至2012年12月我们收治的45例小儿先天性胆总管囊肿患儿临床资料，其中囊肿型32例，梭形扩张型13例，囊肿直径约1．2-5．5em，均在腹腔镜下行胆总管囊肿根治术，空肠Roux-en-Y吻合在腹壁外经脐部小切口进行，肝肠吻合在腹腔镜下完成。结果本组45例中，1例因炎症较重，游离囊肿前壁时渗血较多，解剖困难而中转开腹手术；1例术后6d进食后出现乳糜腹（经肠内、肠外营养14d后治愈）。其余43例均未出现并发症，痊愈出院。术后平均住院时间11d。结论初期开展腹腔镜下胆总管囊肿切除手术时要严格挑选病人，先从囊肿小、炎症轻、发病时间短的病例开始，逐渐积累经验后再扩大腔镜手术指征。腹腔镜手术具有创伤小、视野清晰、恢复快，并发症少等优点。腹腔镜下胆总管囊肿切除术是先天性胆总管囊肿的理想手术方法。Objetive To summarize the experience of Laparoscopic choledoehal cyst excision and Roux- en-Y hepaticojejunostomy in children. Methods From January 2010 to December 2012, we performed a lapa- roscopic choledochal cyst excision procedure on 45 patients, of these, 32 were classified as cystic dilatation type, and 13 were spindle dilatation type, the range of cyst diameter was 1.2 - 5.5 cm, laparoscopic excision of congenital choledoehal cyst was underwent on all the patients. Roux-en-Y jejunojejunostomy was performed extracorporeally through an umhilieal incision, and then hepaticojejunostomy anastomosis was implemented in- tracorporeaily by the laparseopic. Results One of the 45 cases was converted to open surgery because of se- vere haemorrhage due to recurrent inflammation -caused tight adhesion between the cyst and surround tissues; One child exhibited chylous abdominal six days after surgery （cured by enteral and parenteral nutrition for 14 days）. There were no complications occurred in the remaining 32 children whom left the hospital when recov- ered. The average postoperative hospital stay is 11 days. Conclusion To carry out laparoscopie choledoehal cyst resection preliminarily, one should select the patients strictly, the patients with small cysts,mild inflamma- tion and short time after onset would be the best option at the beginning, then accumulate clinical experiences gradually before undergoing laparoseopic operation. Laparoscopic choledochal cysts radical resection has advan- tages include minor invasion, high definition in operation; quick recovering, few complications and short hospi- tal stay. Laparoscopic congenital eholedoehal cyst resection is the best operation method for eholedochal cyst disease.

关 键 词：腹腔镜 胆管畸形 儿童 

分 类 号：R657.4[医药卫生—外科学]