运用经脐单切口腹腔镜技术治疗胆总管囊肿的疗效分析  

Efficacy analysis of applying single-incision laparoscopy for choledochal cyst

作　　者：李飞[1] 张杰 黄璜[1] 覃智杰 周洲[1] 范霞[1] 罗淼[1] 何国庆[1] 高汝黔[2] 唐应明[1] Li Fei;Zhang Jie;Huang Huang;Qin Zhijie;Zhou zhou;Fan Xia;Luo Miao;He Guoqing;Gao Ruqian;Tang Yingming(Department of Pediatric Surgery,Guizhou Provincial People's Hospital,Guiyang 550002,China;Department of Otolaryngology,Guizhou Provincial People's Hospital,Guiyang 550002,China)

机构地区：[1]贵州省人民医院小儿外科,贵阳550002 [2]贵州省人民医院耳鼻喉科,贵阳550002

出　　处：《中华小儿外科杂志》2021年第7期604-609,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨运用经脐单切口腹腔镜下胆总管囊肿切除、肝管空肠Roux-en-Y吻合术治疗儿童胆总管囊肿的效果,总结临床体会。方法收集155例于2013年1月至2019年10月在贵州省人民医院确诊为胆总管囊肿并接受同一主刀医生施行的经脐单切口腹腔镜下胆总管囊肿切除、肝管空肠Roux-en-Y吻合术患儿的相关资料。其中男44例,女111例;平均年龄为4.3岁,年龄范围为2个月至13.7岁;Ⅰ型134例,Ⅳ型21例(Todani分型)。结果除3例患儿中转开腹手术,1例转为4孔腹腔镜手术外,余151例患儿均行经脐单切口腹腔镜下胆总管囊肿切除、肝管空肠Roux-en-Y吻合术;术中平均出血量为10 ml,平均手术时间为3.3 h,手术时间范围为2.0~5.3 h,术后留置腹腔引流管的时间范围为3~5 d,出院时间范围为术后6~8 d。经脐单切口腹腔镜下肝管空肠Roux-en-Y吻合术无明显学习曲线,且并发症的发生率与手术时间的长短无相关性,胆总管囊肿的直径及切除时间与手术时间呈正相关。术中损伤十二指肠1例,同期行腹腔镜下十二指肠修补术;胰管损伤1例,中转开腹行胰肠吻合术;术后出现胆漏2例,对其中1例行保守治疗,另1例行穿刺引流后痊愈;肠坏死1例,行肠切除、肝管十二指肠吻合术;胰漏1例,行穿刺引流后痊愈;术后迟发出血1例,行再次手术止血;脐部切口疝1例自行愈合。术后中位随访时间为4.3年,随访时间范围为2个月至6年。行肠切除的1例患儿在术后2个月出现呕吐、腹泻,家属于当地医院就诊,放弃治疗后死亡;2例出现胰腺炎,行保守治疗后痊愈;1例出现门静脉海绵样变性,目前尚在随访中。所有患儿均无吻合口狭窄、胆管炎等并发症,肝功能正常。结论运用经脐单切口腹腔镜下胆总管囊肿切除、肝管空肠Roux-en-Y吻合术治疗儿童胆总管囊肿是安全可靠的,疗效确切,切口美观。Objective To summarize the technical experiences of applying single incision laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy(SILH)for choledochal cyst(CDC)in children.Methods From January 2013 to October 2019,respective reviews were performed for 155 children undergoing SILH by a single attending surgeon.There were 44 boys and 111 girls with an age range of 2 months to 13.7 years.According to the Todani's classification,the clinical types were I(n=134)and IV(n=21).Results Except for three conversions into laparotomy and another conversion into conventional four-port laparoscopic hepaticojejunostomy,SILH was successfully completed in 151 patients.The operative duration was 2.0-5.3 h,.The mean postoperative hospital stay and duration of drainage in SILH were(6-8)and(3-5)days respectively.The average intraoperative volume of blood loss was 10 ml.SILH had no obvious learning curve and no correlation existed between the incidence of complications and operative duration.Diameter of choledochal cyst and time of cyst resection were positively correlated with operative duration.One child of intraoperative duodenal injury underwent laparoscopic duodenal repair during the same period.One case of pancreatic duct injury underwent pancreaticojejunostomy and converted into laparotomy.Two cases of bile leaks were treated conservatively and percutaneous pucture catheter drainage guided by ultrasound under local anesthesia.One case of intestinal necrosis underwent open necrosis intestinal resection and hepaticoduodenostomy.One case of pancreatic leakage was cured after puncture and drainage.One case of postoperative hemorrhage was reoperated for arresting leeding;bleeding Umbilical incisional hernia healed spontaneously in 1 case.The postoperative follow-up period was 2 to 72 months.Children with intestinal resection had emesis and diarrhea at 2 months and died after family giving up treatment at another local hospital.Two cases of pancreatitis were cured after conservative measures.One case of postoperative cavernous

关 键 词：胆总管囊肿 腹腔镜 儿童 

分 类 号：R657.4[医药卫生—外科学]