腹腔镜治疗小儿胆道穿孔12例临床体会

The clinical experience of laparoscopic treatment of 12 children with biliary perforation

目的:总结腹腔镜手术治疗小儿胆道穿孔的临床体会。方法:2008年12月至2015年12月收治12例胆道穿孔患儿,均经腹腔镜探查证实为胆道穿孔,根据病情分别行胆总管囊肿T管引流+腹腔引流、胆囊造瘘术+腹腔引流、单纯腹腔引流。结果:12例患儿均成功完成手术,术后未出现胆道出血、胆漏等并发症。胆汁引流及腹腔引流24~72 h后,临床症状缓解,腹痛显著减轻,体温降至正常,黄疸逐步消退。8例胆总管囊肿穿孔患者术后6个月行二期胆总管囊肿切除、肝总管空肠Roux-Y吻合术,其中5例在腹腔镜下完成二期手术,3例因胆总管周围粘连重、分离困难中转开腹。结论:腹腔镜用于小儿自发性胆道穿孔的诊断与治疗避免了盲目开腹探查的缺点,创伤小,手术视野广,对腹腔及肠管干扰小,手术时间短,胆总管囊肿穿孔不影响二次腹腔镜手术。

Objective：To summarize the clinical experience of laparoscopic treatment of pediatric biliary perforation.Methods：From Dec.2008 to Dec.2015,12 cases of pediatric biliary perforation were confirmed by laparoscopy.According to the disease,patients underwent common bile duct cyst T tube drainage with abdominal drainage,gallbladder fistula and abdominal drainage,or simple peritoneal drainage.Results：All 12 patients had been successfully operated without biliary tract bleeding,biliary leakage or other complications.After 24 to 72 h,abdominal pain significantly reduced,and the body temperature dropped to normal,meanwhile,jaundice gradually subsided.8 patients with choledochal cyst perforation accepted secondary surgery for cyst excision and Roux-Y hepaticojejunostomy after 6 months,5 patients underwent laparoscopy and 3 were converted to an open procedure due to severe adhesion around the common bile duct.Conclusions：Laparoscopic diagnosis and treatment for children with spontaneous perforation of bile duct eliminates the shortcomings of open operations.It can decrease trauma degree,broaden surgical field,reduce abdominal and intestinal interference,and shorten the operation time.Choledochal cyst perforation does not affect the secondary laparoscopic surgery.