经腹腔镜行先天性胆总管囊肿切除肝管空肠Roux-Y吻合术的探讨

Laparoscopic Total Cyst Excision with Roux-Y Hepatoenterostomy for Choledochal Cyst

目的 探讨经腹腔镜行先天性胆总管囊肿切除,肝管空肠Roux-Y吻合术的可行性。方法 先天性胆总管囊肿5例,在腹腔镜监视下行胆囊穿刺胆道造影术,显示肝胆管和胰管病变,用电切或电凝切除胆总管囊肿。经脐部切口提出空肠,于腹壁外行空肠Roux-Y吻合,用5-0可吸收缝线,在腹腔镜监视下,将肝管与空肠端侧吻合。 结果 本组5例患儿手术全部成功,手术时间平均为5.1 h,(4.5h～6h)出血量20ml～50ml,吻合口直径1.0cm～1.5cm,平均住院时间6.5d,术后随访1个月～4个月,无肠粘连梗阻和吻合口狭窄发生。患儿肝功能各项指标正常。 结论 经腹腔镜行先天性胆总管囊肿切除,肝管空肠吻合术是一种安全可靠的方法,具有创伤小,视野清楚,分离缝合准确、术后恢复快等优点。

Objective To assess the efficacy of laparoscopic total cyst excision with Roux-Y hepatoenterostomy for choledochal cyst in children. Methods Five patients with choledochal cyst ( mean age 3.6 years, 2 boys and 3 girls) underwent laparoscopic cyst excision with Roux-Y hepatoenterostomy between from July 2001 to December 2001. The choledochal cysts were type I with the mean diameter 4.1 cm (2.5cm to 8 cm). Four trocars were utilized with 3 to 5 mm instumentation. Under laparoscopic guidance, intraoperative cholangiogram was performed, the gallbladder and the dilated bile duct were completely excised. To reduce the duration of pneumoperitoneum, a Roux-Y hepatoenterostomy was divided into two stages: a Roux-Y jejunal anastomosis was performed extracorporeally by prolapsing the jejunum through the minimal umbilical incision (2 cm) , and an end-to-side anastomosis was carried out introcorporeally by the continuous hand suture methods between the stump of the hepatic duct and the Roux-en-Y limb. This combination of procedures was as safe and technically easy as conventional surgery. Results Mean duration of operation was 5.1 hours (4.5 to 6.0 hours), intraoperative bleeding were 20 to 50 ml without necessity for blood transfusion. Hospital stay after the operation ranged from 6 to 8 days without delayed complication on followed-up visits. There was no intra-or postoperative complication. Conclusion Laparoscopic total cyst excision with Roux-Y hepatoenterostomy is effective and safe for children with choledochal cyst. Hospital stay and recovery time is short.