腹腔镜胆总管十二指肠吻合术治疗恶性梗阻性黄疸

Laparoscopic choledochoduodenostomy for malignant obstructive jaundice

目的:回顾分析腹腔镜胆总管十二指肠吻合术病人临床资料,探讨腹腔镜胆总管十二指肠吻合术在治疗恶性梗阻性黄疸中的应用。方法:总结本院2009年6月至2012年10月因恶性梗阻性黄疸行腹腔镜胆总管十二指肠吻合术96例病人的手术经验及其随访结果。结果:平均手术时间(103±43)(45～215)min,术中出血约20 mL。6例出现术后近期并发症,其中2例腹腔出血,予以手术止血,3例胆漏,另1例腹腔感染。术后平均住院(9±2)(3～14)d。术后随访4例出现远期并发症,其中2例十二指肠梗阻行胃肠吻合,另2例再次黄疸,分别予以ERCP和经皮肝穿刺引流。术后平均生存期为(7.6±2.8)(2～24)个月。结论:腹腔镜胆总管十二指肠吻合术安全可行,在恶性梗阻性黄疸的姑息性治疗中具有效果确切、创伤小、康复快、并发症少的优点。

Objective To summarize the clinical data of patients with laparoscopic choledochoduodenostomy to study the application of laparoscopic choledochoduodenostomy in the treatment of malignant obstructive jaundice. Methods A retrospective analysis was performed on 96 patients with laparoscopic choledochoduodenostomy for malignant obstructive jaundice from Jun 2009 to Oct 2012 and the patients were follow-up. Results The mean operation time was（103±43）（45- 215） min and mean blood loss was 20 mL. Six cases had early complications postoperatively of which 2 cases with intraabdominal bleeding were re-operated and 3 cases had bile leak and 1 case abdominal infection. The median postoperative stay was （9±2） （3-14） days. Long-term complications were found in 4 cases by postoperative follow-up. Two cases with duodenal obstruction were treated by gastrointestinal anastomosis. The other two cases had recurrence of obstructive jaundice of which one case was given ERCP and another PTCD. The median survival for the patients postoperative was （7.6±2.8）（2-24） months. Conclusions Laparoscopic choledochoduodenostomy is a safe and feasible surgical choice for the palliative treatment of malignant obstructive jaundice. It has many advantages such as exact therapeutic effect, minimally invasive surgical trauma, less pain and quicker recovery with fewer complications.