有上腹部手术史的患儿行腹腔镜胆总管囊肿根治术的体会

Surgical experiences of laparoscopic choledochal cyst resection in patients with previous upper abdominal surgery

目的探讨腹腔镜胆总管囊肿根治术在既往有上腹部手术史患儿中的可行性及特点。方法收集2012年2月至2015年2月我院收治的15例既往有上腹部手术史且行腹腔镜胆总管囊肿根治术病例的临床资料，分析术前术中应注意事项，总结相关经验。所有病例常规采用Hasson技术进腹建立第一孔作为观察孔，根据腹腔粘连情况，调整置入操作器械，四孔法手术，在腹腔镜下进行分离粘连及腹腔探查，获取合适的腔镜手术操作空间，进而行胆总管囊肿切除以及肝管空肠Roux-en-Y吻合术。结果11例在腔镜下完成手术，4例中转开腹手术，其中2例由于手术区域渗血多中转开腹手术，2例由于肝门区域致密粘连中转开腹手术，中转率26．7％0（4／15）。所有患儿术中未发生腹腔镜手术副损伤，术后未发生胆汁漏、腹腔感染等并发症，均康复出院，住院时间6～10d（平均7．6d）。结论采用腹腔镜技术治疗既往有上腹部手术史的患儿是安全可行的，需要外科医师有丰富的腔镜外科手术经验，但宜从宽掌握中转开腹手术指征，确保手术安全。

Objective To explore the feasibility and characteristics of laparoscopic choledochal cyst resection in patients with previous upper abdominal surgery. Methods A total of 15 patients with previous upper abdominal surgery undergoing laparoscopie choledochal cyst resection were collected. Hasson technique was adopted for securing an inspection hole. And operating apparatus were inserted according to the status of abdominal adhesion. They underwent four-port operations and adhesion dissecting and abdominal exploration were conducted laparoseopically. And then laparoscopic choledochal cyst excision and hepatic duct jejunum Roux-en-Y anastomosis were performed. Results Among them, 11 cases underwent laparoscopy while the remainder was converted into open procedures. The conversion causes were profuse blood oozing （n = 2） and severe adhesion （n = 2）. And the conversion rate was 26. 7% （4/15）. Neither subsidiary injury nor complication was found. All of them recovered well and were discharged. The average hospital stay was 7.6 （6- 10） days. Conclusions If performed by surgeons with extensive experiences of endoscopic surgery, laparoscopic chotedochal cyst resection is both safe and effective for patients with previous upper abdominal surgery. However, the surgical indications for converting into open operation should be for ensuring safety.