儿童胆总管囊肿腹腔镜治疗的技术细节分析(附36例报告)

Technical details in laparoscopic treatment of choledochal cyst in children:a report of 36 cases

目的分析儿童胆总管囊肿腹腔镜治疗的技术细节,以期手术安全、高效的完成。方法回顾性分析2014年6月至2018年6月36例湖南省人民医院肝胆外科的儿童胆总管囊肿行腹腔镜治疗的临床资料,尤其关注术中技术细节。结果 36例患儿均顺利完成腹腔镜胆总管囊肿切除、肝管空肠Roux-en-Y吻合术,手术时间(215±35) min,术中出血量(34±22) ml,术后拔除胃管时间(2. 4±1. 2) d,术后拔除腹腔引流管时间(6. 0±2. 2) d,术后恢复饮食时间(2. 8±1. 0) d,术后住院时间(7. 9±1. 9) d。有3例患儿出现了术后并发症,发生率为8. 3%,无死亡病例。结论腹腔镜手术是治疗儿童胆总管囊肿安全、有效的治疗方式,良好的运用Trocar设置、囊肿剥除及消化道重建中的一些技术细节可保证手术安全高效的完成。

Objective To improve the safety and efficiency of laparoscopic surgery in children with choledochal cyst through analyzing the technical details during the operating process. Methods Clinical data of 36 children who were finally diagnosed as choledochal cyst and receiving laparoscopic treatment were analyzed retrospectively,with emphasis on the intraoperative technical details. Results Laparoscopic choledochal cyst resection and hepatojejunostomy with Roux-en-Y anastomosis were completed successfully for all patients,The operation time and volume of intraoperative blood loss were( 215 ± 35) minutes and( 34 ± 22) ml,The indwelling time of nasogastric tube and abdominal drainage tube were( 2. 4 ± 1. 2) d and( 6. 0 ± 2. 2) d,The resumption time of normal diet was( 2. 8 ± 1. 0) d and the postoperative stay was( 7. 9 ±1. 9) d. The postoperative complication was found in 3 patients( 8. 3%) and no deaths occurred.Conclusions Laparoscopic surgery is a safe and effective method in treating children with choledochal cyst.Several technical details,including proper trocar setting,cyst-strippings and digestive tract reconstructions,can effectively improve the efficiency and safety of the operation.