经脐单一切口腹腔镜先天性胆总管囊肿切除肝管空肠Roux—en—Y吻合手术技巧  

Laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy for choledochal cyst by using single incision technique

作　　者：侯文英[1] 李龙[1] 明安晓[1] 张金山[1] 李颀[1] 董宁[1] 刘垚[1] 王海斌[1] 叶茂[1] 

机构地区：[1]首都儿科研究所外科,北京100020

出　　处：《中华小儿外科杂志》2013年第7期497-500,共4页Chinese Journal of Pediatric Surgery

基　　金：国家“十一五科技计划课题（2006BA105A06）;北京市科技计划课题（D101100050010064）;北京市科技计划课题（D101100050010064）

摘　　要：目的总结经脐部单一切口腹腔镜胆总管囊肿根治性切除肝管空肠Roux-ervY吻合术治疗先天性胆总管囊肿手术经验。方法2011年6月至2012年3月收治先天性胆总管囊肿患儿42例，男11例，女31例，年龄2个月～9岁，平均3．6岁。经脐部切口长度1．5～2．0cm，脐环内置人5mTrocar，导入腹腔镜，在脐窝Trocar的左右上方1锄处分别置入2个3mm Trocar；完成胆囊和胆总管前壁的悬吊，显露肝门，套管针刺入胆囊腔，注人造影剂造影。腹腔镜下完整切除胆囊和胆总管囊肿，距Treitz韧带12-17cm处提起空肠，延长脐部切口，取出切除标本，提出空肠体外，吻合肠管，送回肠管至腹腔，重新建立气腹，完成腹腔镜肝管空肠吻合，经右侧31TlnlTrocar孔放置引流管，固定于脐部下方切口。结果41例患儿均行脐部单一切口完成腹腔镜胆总管囊肿根治性切除肝管空肠Roux-en-Y吻合术治疗先天性胆总管囊肿手术，1例因囊肿周围粘连重，渗血较多中转为4孔腹腔镜手术。手术时间220-450min，平均264min，出血量5～10ml，平均7ml，无中转开腹病例，无术中术后输血者。术后24~48h停止胃肠减压，进食进饮，术后72h复查B超，拔除腹腔引流管。并发胆漏2例，经腹腔穿刺引流后治愈。其余患儿术后恢复顺利，术后1、3、6个月随诊，复查腹部B超，生化和上消化道造影检查，无胆管炎，胰腺炎和结石发生。未见腹腔积液，无空肠肝支反流病例。结论经脐部单一切口腹腔镜行胆总管囊肿根治性切除＋肝管空肠Roux-en-Y吻合术治疗先天性胆总管囊肿安全可行，手术打击小，预后良好，需有熟练4孔腹腔镜手术技术，并掌握单切口的手术技巧。Objective To summarize the technical experience and skill in laparoscopic total cyst excision with Roux-en-Y Hepatoenterostomy for choledochal cyst through single incision. Methods Forty-two patients with choledochal cyst underwent laparoscopic cyst excision with Roux-en-Y Hepatoenterostomy through single incision between June 2011 and March 2012. Their age ranged from 2 month to 9 years （average age 3. 6 years）. Single incision and three ports were utilized with 3 to 5ram instrumentation. The gallbladder and the dilated bile duct were completely excised. The Roux- en-Y jejunojejunal anastomosis was performed extracorporeally by exter^orizing the jejunum through the single umbilical incision, and an end-to-side anastomosis was carried out intracorporeally by continuous hand suture methods between the stump of the hepatic duet and Roux-en-Y limb. Results Cystic excision with hepaticoenterostomy was accomplished laparoscopieally in 41 cases through single umbilical incision without conversion. One ease was performed with 4 ports laparoscopic technique because of proximal serious adhesions in choledochal cyst. Average duration of operation was 264 min （220-450 rain）, intraoperative bleeding was 5 to 10ml without necessity for blood transfusion. The postoperative course was uneventful in 40 infants with hospital stay range from 3 to 6 days after the operation. Two cases were complicated by bile leakage. There was no postoperative complication during 3 months to 9 months follow-up. Conclusions Laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy through the single umbilical incision is feasible, safe and effective for the treatment of choledochal cyst in infants.

关 键 词：胆总管囊肿 腹腔镜检查 吻合术 Roux-en-Y 

分 类 号：R726[医药卫生—儿科]