丝线悬吊肝外胆道系统在腹腔镜胆总管囊肿根治术中的应用  

Experiences of traction suturing in extrahepatic biliary system during laparoscopic resection of choledochal cyst in children

作　　者：黄一敏[1] 刘江斌[1] 徐伟珏[1] 吴一波[1] 朱琳琳[1] 余胜华 吕志宝[1] 

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院普外科,200062

出　　处：《中华小儿外科杂志》2016年第10期746-749,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的总结丝线悬吊肝外胆道系统在腹腔镜胆总管囊肿根治术中的应用经验。方法回顾性分析上海市儿童医院／上海交通大学附属儿童医院2010年3月至2014年12月采用腹腔镜治疗的52例小儿胆总管囊肿病例的临床资料。按是否采用丝线悬吊肝外胆道系统分为两组：A组14例，采用传统4Trocar技术（未采用丝线悬吊），由3人完成手术；B组38例，采用3Trocar并丝线悬吊肝外胆道系统，由2人完成手术。丝线悬吊部位分别为：肝圆韧带、胆囊窝和胆总管囊肿壁。比较两组的手术时间、出血量和住院时间等指标，并总结丝线悬吊的应用体会。结果A组手术时间（437±45）min，出血量（15±5）ml，住院时间（14±4）d；B组手术时间（301±41）min，出血量（10±4）ml，住院时间（13±5）d。两组的手术时间差异有统计学意义（P〈0．01），其他指标差异无统计学意义（均P〉0．05）。A组中2例因术中助手暴露推挤，导致十二指肠浆肌层损伤，即刻缝补后愈合；两组各有1例胆漏，经引流等保守治疗自愈；余未见其他手术并发症。B组由于采用丝线悬吊技术，除了减少1个Trocar和手术助手外，更有助于保持稳定的术野暴露。结论丝线悬吊肝外胆道系统在腹腔镜胆总管囊肿根治术中是可行的。与4Trocar技术比较，减少了手术时间和Trocar的使用，是一项值得推广的技术。但需要由腹腔镜操作经验丰富的术者实施。Objective To summarize the experiences of laparoscopic resection of choledochal cyst by traction suturing in extrahepatic biliary system during laparoscopic resection of choledochal cyst in children. Methods A total of 52 patients of choledochal cyst underwent laparoscopic resection of choledoehal cyst from March 2010 to December 2014 at Shanghai Children＇s Hospital/Shanghai Jiao Tong University. They were divided into two groups according to whether or not using traction suturing during laparoscopy. That is, group A （n = 14） without traction suturing in 4 Trocars by 3 surgeons and group B （n = 38） using traction suturing in 3 Trocars by 2 surgeons. Traction sutures were placed at round ligament, gallbladder bed and cyst wall respectively in group B. The clinical parameters of operative duration, blood loss volume, postoperative hospital stay and experiences of traction suturing were analyzed. Results The clinical parameters of both groups were operative duration （437± 45 vs 301 ± 41） min, blood loss volume （15 ± 5 vs 10 ± 4） ml and postoperative hospital stay （14 ± 4 vs 13 ± 5） days. And the operative durations of two groups were significantly different （P〈0. 01）. However, no difference existed in other aspects （all P〉0. 05）. In group A, duodenal wall was damaged intraoperaively （n = 2）. There was 1 case of biliary leakage in each group while no complication occurred in neither group. Traction suturing could not only reduce the number of Trocars, but also create an excellent exposure of operative field. Conelmiorts Traction suturing of extrahepatic biliary system is feasible for laparoscopic resection of choledochal cyst in children. And it shortens operative duration and reduces the number of Trocars.

关 键 词：胆总管囊肿 腹腔镜检查 丝线 

分 类 号：R726.5[医药卫生—儿科]