腹腔镜手术治疗肝总管细小型及合并副肝管变异的先天性胆道扩张症  

Laparoscopy for congenital biliary dilatation with a small diameter of common hepatic duct or accessory hepatic ducts:a report of 11 cases

作　　者：章跃滨[1] 高志刚[1] 陈青江[1] 蔡多特[1] 熊启星[1] 章立峰[1] 潘涛[1] 罗文娟[1] Zhang Yuebin;Gao Zhigang;Chen Qingjiang;Cai Duote;Xiong Qixing;Zhang Lifeng;Pan Tao;Luo Wenjuan(Department of General Surgery,Affiliated Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属儿童医院,浙江省杭州市310000

出　　处：《临床小儿外科杂志》2021年第11期1054-1058,共5页Journal of Clinical Pediatric Surgery

基　　金：国家重点研发计划(编号:2018YFC1002700);浙江省医药卫生科技计划项目(编号:2017KY434)。

摘　　要：目的探索腹腔镜手术治疗肝总管细小型及合并副肝管变异的先天性胆管扩张症(congenital biliary dilatation,CBD)的安全性和有效性。方法以2012年1月至2019年8月期间在浙江大学医学院附属儿童医院接受手术治疗的11例肝总管细小型及合并副肝管变异的CBD患者为研究对象,包括胆总管远端囊性扩张而近端及肝总管细小4例,合并副肝管变异7例。根据术前影像和术中情况选择不同手术方式治疗,随访术后恢复情况。结果11例手术过程顺利,平均手术时间158 min,范围120~210 min;术中出血均<10 mL,无一例中转开腹手术。术后7~14 d顺利出院,住院期间无胆瘘及胆道感染、狭窄等并发症发生,术后随访2个月至3年。均无胆红素升高、转氨酶异常、胆道狭窄或扩张及胆管炎等并发症发生。结论肝总管细小型和合并副肝管变异的CBD的诊断主要依靠影像学检查,但大部分副肝管无法通过术前影像学检查发现。术中遇到肝总管直径<5 mm的患者时,在肝总管前壁纵向向上剖开少许前壁后,在悬吊线辅助下行胆肠间断吻合,可降低术后吻合口狭窄的发生率。术中发现合并副肝管畸形、副肝管直径<1 mm、无法行吻合者,可单独结扎处理;对于副肝管直径≥2 mm者,建议重建胆肠吻合。对于副肝管与肝总管距离较近者,可无张力合并后行纺锤形吻合,降低手术难度,减少吻合口狭窄的发生。Objective To explore the safety and feasibility of laparoscopy for unusual forms of congenital biliary dilatation(CBD)with a small diameter or accessory hepatic duct(AHD).Methods Retrospective analysis was performed for 11 CBD cases with unusual forms undergoing laparoscopy from January 2012 to August 2019.And the relationship between operative procedures and postoperative recovery were retrospectively analyzed.Results Laparoscopy was completed successfully for all 11 cases.The average operative duration was 158(120-210)min and the volume of intraoperative blood loss<10 mL.During a follow-up period of(2-36)months,the levels of AST,ALT and bilirubin remained normal and there was no associated dilatation of intrahepatic bile duct.Conclusion The diagnosis of CBD is dependent on radiography.However,most cases of AHD fail to be detected preoperatively.Laparoscopic discontinuous hepaticojejunostomy may be performed by making a longitudinal incision in anterior wall of CHD under traction with a diameter of CHD<5 mm.A ligature was used in AHDs when the diameter was less than 1 mm,and the AHD was restructured into a Roux loop along with the common hepatic duct when the diameter was more than 2 mm.

关 键 词：先天性胆管扩张症 肝总管 腹腔镜手术 治疗 

分 类 号：R722[医药卫生—儿科] R657.44[医药卫生—临床医学]