腹腔镜先天性胆管扩张症手术相关并发症的防治

Laparoscopic cyst resection for congenital biliary dilatation： single center experience and lessons

目的 评价腹腔镜先天性胆管扩张症根治手术的效果并探讨其并发症的防治.方法 回顾2002年6月至2009年12月间65例腹腔镜胆管扩张症根治术的临床资料,分析术中和术后并发症的原因以及随访情况.结果 64例腹腔镜下顺利根治切除扩张胆总管,21例肝门胆管狭窄同时切开成形术;1例胰腺内胆总管远端囊肿因累及胰腺和十二指肠而中转开腹手术.术中或围手术期出现并发症5例,包括1例门静脉损伤、2例暂时性胆漏、1例胆支空肠袢扭转和1例应激性溃疡.随访3个月～7.5年,1例Ⅳ型复合型囊肿发生肝门吻合口狭窄.本组没有死亡率.结论 ①腹腔镜手术并发症发生率与开放手术相当,可在小儿安全实施并可取得满意效果;②为减少手术并发症应根治切除囊肿,对于常见Ⅰ型囊肿可保留肝管便于吻合,对于Ⅳ型病变应切开狭窄肝管、扩大开口斜行吻合.

Objective To retrospectively review the experience and lessons of laparoscopic surgery for congenital biliary dilatation （CBD） in children. Methods Between June 2002 and December 2009, the clinical data of 65 children who had undergone laparoscopic CBD resection at this center were retrospectively reviewed. Intraoperative and postoperative complications were recorded. All patients were followed up after discharged from the hospital. Results Patients were followed up for 3 months to 7.5 years. The total resection of CBD and the intracorporeal hepaticoenterostomy were achieved in 64 children, of which 21 patients with biliary stenosis in the porta hepatis underwent ductoplasty. The conversion of laparoscopic surgery to open surgery occurred on 1 patient due to intrapancreatic choledochocele involved pancreas and duodenum. The intraoperative or perioperative complications were noted in 5 cases including portal vein injury in 1 case, temporary bile leakage in 2 cases, a torsion of the jejunal Roux loop in 1 case and stress ulcer in 1 case. One patient with a type Ⅳ cyst developed hepaticojejunal anastomotic stricture after surgery. Conclusions Laparoscopic surgery is safe and effective for congenital biliary dilatation resection in children.