The authors present a 3-month-old patient with a congenital choledochal cyst, which was asymptomatic until treatment. On laparoscopy, a type I choledochal cyst was confirmed and excised laparoscopically. A Roux-en-Y a...The authors present a 3-month-old patient with a congenital choledochal cyst, which was asymptomatic until treatment. On laparoscopy, a type I choledochal cyst was confirmed and excised laparoscopically. A Roux-en-Y anastomosis was constructed after exteriorization of the small bowel via the infraumbilical trocar incision. A laparoscopic end-to-side hepaticojejunostomy was carried out. The operation lasted 41/2 hours, without intraoperative problems. Oral food intake was started on day 2 and well tolerated with bile stained stools. Symptoms of bowel obstruction occurred on day 8. On minilaparotomy, the Roux-en-Y anastomosis was found to be adherent to the mesenterium of the colon, leading to obstruction. After mobilizing the loop, the postoperative course was uneventful. We conclude that laparoscopic resection of congenital choledochal cyst and choledochojejunostomy was feasible in the youngest patient operated on so far. However, adhesive small bowel obstruction can also occur, as after conventional operation, when the bowel is exteriorized for Roux-en-Y hepaticojejunostomy.展开更多
1988年5月至1980年6月,我们共施行间置空肠人工乳头胆管空肠吻合术二例,特报告如下: 临床资料例一男,69岁,1988年5月住院。一周前无任何诱因右上腹持续疼、痛阵发性加剧,向后背部放散。周身粘膜、皮肤黄染,发烧,寒战。黄染目渐加重。经...1988年5月至1980年6月,我们共施行间置空肠人工乳头胆管空肠吻合术二例,特报告如下: 临床资料例一男,69岁,1988年5月住院。一周前无任何诱因右上腹持续疼、痛阵发性加剧,向后背部放散。周身粘膜、皮肤黄染,发烧,寒战。黄染目渐加重。经门诊检查及 B 超诊断为“胆囊炎、胆石症”收住院。位院后行间置空肠人工乳头术,取出大小不等四枚结石,并切除胆囊。展开更多
文摘目的探讨胆总管侧壁 T 管引流术在腹腔镜胆囊切除术( laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术( laparoscopic common bile duct exploration,LCBDE)应用的临床疗效。方法 2016 年 7 月~ 2018 年 9 月在我院行 LC+LCBDE 的 175 例胆囊合并胆总管结石患者,按随机数字表法分为两组,采用不同位置引出 T 管:胆总管前壁 T 管引流(前壁组) 88 例,胆总管侧壁 T 管引流(侧壁组) 87 例。比较两组术中出血量、T 管放置时间、缝合胆总管时间、术后肛门排气时间、腹腔引流时间、胆汁引流量、术后至 T 管完全夹闭时间、住院时间、住院费用、患者耐受 T 管的主观感受及术后并发症等。结果两组患者术中出血量、术中安放 T 管时间、术后肛门排气时间、腹腔引流时间、日均胆汁引流量、术后至完全夹闭 T 管时间、术后住院时间、住院费用及患者耐受 T 管的 VRS 评分比较均无统计学差异( P>0.05),但侧壁组术中缝合胆总管时间较前壁组少,差异有统计学意义( P<0.05)。所有患者均获随访,时间 2 ~ 36 月。随访期内均未出现术后出血、腹腔感染、黄疸、急性胆管炎和急性胰腺炎等并发症,经 T 管胆道造影未见胆管狭窄,肝功能均恢复正常。术后前壁组发生胆漏 7 例,结石残留 1 例, T 管拔除困难 2 例,侧壁组胆漏 1 例,结石残留 1 例;组间并发症率比较,差异有统计学意义( 11.36%vs. 2.30%,P<0.05)。结论 LC+LCBDE 胆总管侧壁 T 管引流较前壁 T 管引流更简单、易操作、更安全,值得推广。
文摘The authors present a 3-month-old patient with a congenital choledochal cyst, which was asymptomatic until treatment. On laparoscopy, a type I choledochal cyst was confirmed and excised laparoscopically. A Roux-en-Y anastomosis was constructed after exteriorization of the small bowel via the infraumbilical trocar incision. A laparoscopic end-to-side hepaticojejunostomy was carried out. The operation lasted 41/2 hours, without intraoperative problems. Oral food intake was started on day 2 and well tolerated with bile stained stools. Symptoms of bowel obstruction occurred on day 8. On minilaparotomy, the Roux-en-Y anastomosis was found to be adherent to the mesenterium of the colon, leading to obstruction. After mobilizing the loop, the postoperative course was uneventful. We conclude that laparoscopic resection of congenital choledochal cyst and choledochojejunostomy was feasible in the youngest patient operated on so far. However, adhesive small bowel obstruction can also occur, as after conventional operation, when the bowel is exteriorized for Roux-en-Y hepaticojejunostomy.
文摘1988年5月至1980年6月,我们共施行间置空肠人工乳头胆管空肠吻合术二例,特报告如下: 临床资料例一男,69岁,1988年5月住院。一周前无任何诱因右上腹持续疼、痛阵发性加剧,向后背部放散。周身粘膜、皮肤黄染,发烧,寒战。黄染目渐加重。经门诊检查及 B 超诊断为“胆囊炎、胆石症”收住院。位院后行间置空肠人工乳头术,取出大小不等四枚结石,并切除胆囊。
