儿童Caroli病的病理解剖学特点及微创手术治疗  

Pathologic features and minimal invasive surgical procedures for Caroli disease in children

作　　者：肖元宏[1] 张煊[2] 赵国栋[2] 宋栋达[2] 王刚[2] 王政[1] 刘渠[2] 许大彬[2] 王晓琳[3] 何艳[3] 刘靖[3] 胡明根[2] XIAO Yuanhong;ZHANG Xuan;ZHAO Guodong;SONG Dongda;WANG Gang;WANG Zheng;LIU Qu;XU Dabin;WANG Xiaolin;HE Yan;LIU Jing;HU Minggen(Department of Pediatric Surgery,the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China;Department of 2nd Hepatobiliary Surgery,the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China;Department of Anaesthesia,the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院第一医学中心小儿外科,北京100853 [2]解放军总医院第一医学中心肝胆外二科,北京100853 [3]解放军总医院第一医学中心麻醉科,北京100853

出　　处：《解放军医学院学报》2019年第2期140-144,共5页Academic Journal of Chinese PLA Medical School

基　　金：部委级资助项目;解放军总医院临床科研扶持基金临床重大创新预研项目(2016FC-CXYY-2008)

摘　　要：目的探讨儿童Caroli病的病理解剖学特点及微创手术治疗。方法对2016年7月-2018年10月我中心收治的2例儿童Caroli病术前影像学及术中病理解剖学特点进行描述,探讨全腹腔镜或机器人手术在儿童Caroli病治疗中的应用。患儿1,女性,3岁2个月,体质量14.2 kg,身高100 cm,体表面积0.64 m^2;患儿2,女性,9岁,体质量34.2 kg,身高135 cm,体表面积1.11 m^2。术前均行腹部CT平扫、增强扫描及MRCP检查。患儿1行全腹腔镜胆总管囊肿切除、肝总管空肠Roux-en-Y吻合术;患儿2行Da Vinci机器人胆总管囊肿切除、肝总管空肠Roux-en-Y吻合术。结果患儿1全腹腔镜手术历时225 min,气腹时间190 min,术中失血10 ml;患儿2机器人手术历时300 min,气腹时间270 min,术中失血80 ml。两名患儿围术期恢复顺利,无胆瘘、出血及腹腔感染等并发症,无气腹相关并发症。患儿1随访1年7个月,无胆石,胆红素、胆汁酸、转氨酶正常;患儿2胆红素、胆汁酸、转氨酶恢复正常,术后第19天出院。结论儿童Caroli病存在肝内胆管囊状扩张及胰胆合流异常,胆总管囊肿末端变细并提前汇入胰管。全腹腔镜或机器人完成胆总管囊肿切除、肝总管-空肠端侧吻合、结肠前空肠-空肠侧侧吻合等安全、可行,微创术后效果良好。Objective To study the pathologic features and minimal invasive surgical procedures for pediatric Caroli disease.Methods From July 2016 to October 2018, 2 children suffered from Caroli disease underwent surgery in our hospital. The pathologic results and surgery techniques were reviewed. Case 1 was a girl with age of three years and 2 months, weight of 14.2 kg, height of 100 cm and body surface area of 0.64 m^2. Case 2 was a 9 year-old girl with weight of 34.2 kg, height of 135 cm and body surface area of 1.11 m^2.Plain and enhanced scanning of CT and MRCP examinations were performed before operation. Laparoscopic total intracorporeal correction of choledochal cyst was performed for case 1. Robotic correction of choledochal cyst was performed for case 2. Techniques included cyst excision, Roux-en-Y hepaticojejunostomy and side jejunotomy. Results The operating time, pneumoperitonium time and estimated blood loss were 225 minutes, 190 minutes, 10 ml for laparoscopic total intracorporeal correction of choledochal cyst in case1;and 300 minutes, 270 minutes, 80 ml for robotic correction of choledochal cyst in case 2, respectively. Both of them experienced uneventful recovery postoperatively, without bile ?stula, bleeding and infection, et al. No complications related to pneumoperitoneum occurred. Case 1 was followed up for 1 year and 7 months. No complications such as cholelithiasis occurred. The levels of total bile acid, bilirubin and aminotransferase enzymes were normal. For case 2, the above indicators were declined to the normal values,and she was discharged from hospital at 19 days postoperatively. Conclusion Children suffered from Caroli disease present with saccular dilations of intrahepatic bile duct, and anomalous junction of the pancreatic and common bile ducts. Laparoscopic or robotic intracorporeal correction of choledochal cysts is safe and feasible for Caroli disease in children, including choledochal cyst excision,Roux-en-Y hepaticojejunostomy of the colon anteriorly, and side jejunotomy with laparosc

关 键 词：儿童 胆总管囊肿 微创手术方法 

分 类 号：R657.4[医药卫生—外科学] R726.1[医药卫生—临床医学]