婴幼儿胆总管囊肿腹腔镜根治术探讨  

Clinical analysis of laparoscopy cyst excision of choledochal cyst in children

作　　者：邓莉 邓庆强[2] 杜哲明[3] 周育宏[3] 徐维[2] 罗鸣[2] 张守华[2] 雷俊[2] DENG Li DENG Qingqiang DU Zheming et al(Department of Medical,the Third Hospital of Nanchang,Nanchang,330006 Department of General Surgery,Jiangxi Children＇s Hospital,Nanchang,330006 Department of General Surgery,Hospital of Jiangxi Provincial Armed Police Corps ,Nanchang, 330029, China)

机构地区：[1]江西省南昌市第三医院医务科,南昌330006 [2]江西省儿童医院普外科,南昌330006 [3]武警江西总队医院普外科,南昌330029

出　　处：《江西医药》2017年第7期594-596,共3页Jiangxi Medical Journal

基　　金：江西省科技厅科技支撑计划;编号2014ZBBG70003

摘　　要：目的探讨小儿腹腔镜胆总管囊肿切除、肝总管空肠Roux-en-Y吻合的手术技巧及胆瘘等相关并发症的预防措施。方法回顾性分析2012年3月至2016年12月,经腹腔镜行先天性胆总管囊肿根治术52例患儿的临床资料,分析其手术方法和技巧及主要并发症胆瘘产生的原因。结果 52例患儿均在腹腔镜下完成手术,手术时间230~480min,平均290min。术后早期并发症发生率13.5%(7/52)。其中术后6例胆瘘(死亡1例,再次手术2例),1例胰腺炎。结论胆瘘是腹腔镜胆总管囊肿根治术的主要并发症之一,需注意术前胆道感染的控制、改善肝功能及提高手术的操作技巧。胆瘘保守无效应及早手术探查,尽早缝合瘘口。Objective To investigation the laparoscopic surgical technique and measures for prevention of postoperative biliary fistual in dealing with total cyst excision with Roux-en-Y hepatoenterostomy for choledochal cyst in children. Methods Retrospective analyses were performed for 52 cases belonged to type I of laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy choledochal cyst from March 2012 to December 2016. The surgical method and technique as well as the causes for biliary fistula were analyzed. Results Laparoscopic procedure was completed successfully for all cases. The average operative duration was 290 minutes（range from 230 to 480 minutes）. The morbidity of early postoperative complication was 13.5%（7/52）. The early complications included biliary fistual in 6 patients（one case died,two cases underwent reoperation）,postoperative pancreatitis in 1 patient. Conclusion Biliary fistual is one of the major early postpperative complications. The preoperative treatment of biliary tract infection,hypohepatia and surgical skills during operation especially should be emphasized. Reoperation for biliary fistual should not be delayed,mycotic cholangitis after biliary fistual needs more attention.

关 键 词：胆总管囊肿 腹腔镜 胆瘘 

分 类 号：R726.5[医药卫生—儿科]