重视腹腔镜技术治疗复合型胆管囊肿手术规划与术中处理

Paying great attention to preoperative planning and intraoperative handling during laparoscopic maneuvers for treating mixed choledochal cysts

先天性胆管囊肿是一种胆总管单独或联合肝内胆管扩张的结构发育畸形,多伴有胆胰管合流异常,最常表现为胆总管囊状或梭形扩张,累及肝内胆管囊状扩张或副肝管畸形则被称为复合型胆管囊肿。随着微创技术的进步,腹腔镜胆总管囊肿切除、胆道重建手术在国内广泛开展,同时也开始应用到复合型胆管囊肿肝门胆管畸形的治疗中,但如果术中处理不当,容易发生血管误伤、胆肠吻合引流不畅等情况,继而导致反复胆管炎发作、肝内胆管结石等并发症,应予以重视。

Congenital biliary cyst is a structural abnormality of common bile duct or combined with intrahepatic bile duct dilatation.The most common manifestation is cystic or fusiform dilatation of common bile duct.A complex bile duct cyst involves intrahepatic biliary cystic dilatation or parahepatic duct malformation.With the advancement of mini-invasive techniques,laparoscopic choledochal cyst resection and biliary reconstruction are widely performed domestically for hepatic hilar bile duct malformation in complex bile duct cysts.However,if intraoperative handling is not properly implemented,vascular injuries are prone to occur.Accidental injury,improper biliary anastomosis and drainage may lead to such complications as an onset of repeated cholangitis and a formation of intrahepatic bile duct stones.