腹腔镜下三种不同胆道重建术在先天性胆总管囊肿治疗中的应用  

The application of three different biliary tract reconstruction by laparoscopy in the treatment of congenital choledochal cyst

作　　者：胡博[1] 成广海[1] 詹建兴 申海军[1] 李海民 Hu Bo;Cheng Guanghai;Zhan Jianxing;Shen Haijun;Li Haimin(Department of hepatobiliary surgery,Xi＇ an space General Hospital,Xi ＇ an City,Shaanxi Province,710100)

机构地区：[1]西安航天总医院肝胆外科,西安710100

出　　处：《中华普外科手术学杂志（电子版）》2018年第4期326-329,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家自然科学基金(编号:81672339)~~

摘　　要：目的探讨腹腔镜下胆总管囊肿切除后肝管十二指肠吻合术(A组)、肝管空肠Roux-en-Y吻合术(B组)和改良胆肠袢式吻合术(C组)等三种胆道重建术治疗的临床效果和安全性。方法回顾性分析2012年1月至2016年12月间腹腔镜手术治疗先天性胆总管囊肿的46例临床资料,A组15例、B组17例和C组14例。采用SPSS19.0软件包对数据进行统计描述和分析。术中术后围手术期指标等采用(x±s)描述,组间比较采用单因素方差分析。近期并发症等分类资料采用频数(构成比)描述,组间比较采用Pearsonχ2检验。P<0.05为差异有统计学意义。结果 C组的手术时间、术后通气时间、引流管留置时间和术后住院时间均优于A组和B组,差异有统计学意义(P<0.05)。三种术式术后近期并发症发生率差异无统计学意义(P>0.05)。结论腹腔镜下改良胆肠袢式吻合术与肝管十二指肠吻合术、肝管空肠Roux-en-Y吻合术比较,手术疗效均较理想,同时手术时间更短、术后恢复快、住院时间短等优势,值得临床应用和推广。Objective To investigate the clinical efficacy and safety of three kinds of biliary reconstruction after laparoscopic choledochal cyst resection, including hepatic duct duodenal anastomosis, hepatic duct jejunal Roux-en-Y anastomosis and modified choledoeho loop anastomosis. Methods The clinical data from 46 cases of congenital choledochal cyst treated in our hospital from January 2012 to December 2016 were retrospectively analyzed. 15 cases of hepatic duodenostomy （ group A ） , 17 cases of Roux-en-Y hepaticojejuuostomy （group B） and 14 cases of Modified biliary-enteric Warren Anastomosis （group C） were performed respectively after the resection of choledochal cyst. SPSS19. 0 software package was used for statistical description and analysis of data. Biochemical indicators and perioperative indicators were measured by means of （x±s） and compared with one-way ANOVA. Recent complications and other classification data were described by frequency （constituent ratio）. Pearson chi square test was used for comparison between the two groups. P 〈 0.05 was statistically significant. Results The operative time, postoperative ventilation time, drainage tube retention time and postoperative hospital stay in group C were shorter than those in group A and B, and the difference was statistically significant （ P 〈 0.05 ）. There was no significant difference in the incidence of postoperative complications between the three groups （ P 〉 0.05）. Conclusion Compared with hepatic duodenostomy and hepatic duct jejunum Roux-en-Y anastomosis surgery, laparoscopic modified loop type biliary enteric anastomosis has the similar results, shorter operative time, better postoperative gastrointestinal function recovery and shorter postoperative hospitalization time, which is worthy of promotion.

关 键 词：胆总管囊肿 腹腔镜 胆总管造口术 吻合术 Roux-en-Y 

分 类 号：R657.4[医药卫生—外科学]