杂交腹腔镜策略下Roux-en-Y胆肠吻合术30例临床总结

Laparoscopic Roux-en-Y choledochojejunostomy:Hybrid surgical technique in 30 cases

目的探讨杂交腹腔镜策略下Roux-en-Y胆肠吻合术的可行性和安全性。方法回顾性分析2017年1月至2020年7月在山东省日照市肝胆胰脾外科研究所、山东省滨州市第二人民医院肝胆外科、北京朝阳医院西院肝胆胰脾外科实施杂交腹腔镜策略下Roux-en-Y胆肠吻合术的30例患者的病例资料。结果30例患者中胆总管结石合并Oddi括约肌狭窄15例(50.0%),胆总管扩张合并十二指乳头憩室5例(16.7%),胆管结石伴反流性胆管炎4例(13.3%),胆总管囊肿4例(13.3%),胆管中段癌2例(6.7%);主要临床表现包括恶心伴呕吐15例(50.0%),腹痛24例(80.0%),黄疸伴发热16例(53.3%)。建立气腹后于腹腔镜下处理胆道病变,开腹制作Roux-en-Y,腹腔镜下完成胆肠吻合术,27例(90.0%)脐部延长切口长度为4~6cm,3例(10.0%)因肥胖将脐部切口延长至8cm;远端游离襻为55~60cm;手术时间为185~265min;术中出血量为30~300ml。术后4例发生一过性胆瘘,每日引流量小于50ml,3~7d内愈合;无切口感染及切口疝发生;住院时间13~23d,平均16.7d。术后随访2~44个月,均未发生反流性胆管炎、胆管结石复发、吻合口狭窄等并发症。结论杂交腹腔镜策略下Roux-en-Y胆肠吻合术疗效可靠,安全性好,技术要求简单,费用较低,适用于基层医院及腹腔镜技术尚在学习曲线内的医师。

Objective To investigate the feasibility and safety of Roux-en-Y choledochojejunostomy under hybrid laparoscopic strategy.Method From January 2017 to July 2020,30 patients with Roux-en-Y choledochojejunostomy under hybrid laparoscopic strategy were enrolled in the retrospective study to investigate the clinical data.Result Among the 30 cases,13 patients were males and 17 patients were females;the age rangs was 32 to 80 years old,and the median age was 63 years old;15 cases(50.0%)of choledocholithiasis with Oddi sphincter stenosis,5 cases(16.7%)of choledocholithiasis with duodenal diverticulum,4 cases(13.3%)of choledocholithiasis with reflux cholangitis,4 cases(13.3%)of choledocholithiasis,and 2 cases(6.7%)of carcinoma of the middle bile duct.Main clinical manifestations:nausea with vomiting in 15 cases(50.0%),abdominal pain in 24 cases(80.0%),jaundice with fever in 16 cases(53.3%).The length of the extended umbilical incision in 27 cases(90.0%)was 4-6cm,3 cases(10.0%)had umbilical extensions up to 8cm due to obesity;the length of the bile duct loop was 55-60cm;intraoperative blood loss was 30-300ml.Transient postoperative bile leakage occurred in 4 cases,the amount of drainage was less than 50ml/day,and the wound healed within 3 to 7 days,without incision infection or incisional hernia.The hospitalization time was 13-23days,with an average of 16.7 days,the follow-up time was 2-44 months,and there were no long-term complications such as reflux cholangitis,recurrence of bile duct stones and anastomotic stenosis.Conclusion Roux-en-Y choledochojejunostomy under hybrid laparoscopic strategy has reliable efficacy,safety,simple technical requirements and low cost.It is suitable for primary hospitals and physicians whose laparoscopic technology is still within the learning curve.