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
目的探讨腹腔镜胃袖状切除加空回肠侧侧吻合术(laparoscopic sleeve gastrectomy plus side-to-side jejunoileal anastomosis,JI-LSG)在治疗肥胖症中的应用价值。方法回顾性分析2014年3月至2016年4月在同济大学附属东方医院糖尿病与减...目的探讨腹腔镜胃袖状切除加空回肠侧侧吻合术(laparoscopic sleeve gastrectomy plus side-to-side jejunoileal anastomosis,JI-LSG)在治疗肥胖症中的应用价值。方法回顾性分析2014年3月至2016年4月在同济大学附属东方医院糖尿病与减重外科接受代谢手术治疗的18例肥胖症患者的临床资料。所有患者均签署知情同意书,符合医学伦理学规定。根据接受手术方式的不同将患者分为JI-LSG组和腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)组。其中JI-LSG组9例,男5例,女4例;平均年龄(31±9)岁。LSG组9例,男5例,女4例;平均年龄(31±10)岁。比较两组患者的手术时间、术中出血量、术后住院时间、术后并发症发生情况,以及术后6个月内的体质指数(body mass index,BMI)减少量、多余体重减少百分比(percentage of excess body weight loss,EWL%)和代谢病缓解情况。两组患者临床资料的比较采用t检验和Fisher确切概率法。结果 JI-LSG组患者术后并发症发生率为33%(3/9),与LSG组的22%(2/9)差异无统计学意义(P=0.599)。术后6个月,JI-LSG组患者的BMI减少量和EWL%分别为(15±6)kg/m2和(76±27)%,明显高于LSG组的(10±5)kg/m2和(54±29)%(t=4.60、4.18,P<0.05);两组患者的肥胖相关合并症均得到显著改善。结论 JI-LSG操作难度不高,简单易行,有良好的治疗肥胖症和代谢综合征的疗效,但该术式处于应用初期,需进一步研究以明确其价值。展开更多
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.
文摘目的探讨腹腔镜胃袖状切除加空回肠侧侧吻合术(laparoscopic sleeve gastrectomy plus side-to-side jejunoileal anastomosis,JI-LSG)在治疗肥胖症中的应用价值。方法回顾性分析2014年3月至2016年4月在同济大学附属东方医院糖尿病与减重外科接受代谢手术治疗的18例肥胖症患者的临床资料。所有患者均签署知情同意书,符合医学伦理学规定。根据接受手术方式的不同将患者分为JI-LSG组和腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)组。其中JI-LSG组9例,男5例,女4例;平均年龄(31±9)岁。LSG组9例,男5例,女4例;平均年龄(31±10)岁。比较两组患者的手术时间、术中出血量、术后住院时间、术后并发症发生情况,以及术后6个月内的体质指数(body mass index,BMI)减少量、多余体重减少百分比(percentage of excess body weight loss,EWL%)和代谢病缓解情况。两组患者临床资料的比较采用t检验和Fisher确切概率法。结果 JI-LSG组患者术后并发症发生率为33%(3/9),与LSG组的22%(2/9)差异无统计学意义(P=0.599)。术后6个月,JI-LSG组患者的BMI减少量和EWL%分别为(15±6)kg/m2和(76±27)%,明显高于LSG组的(10±5)kg/m2和(54±29)%(t=4.60、4.18,P<0.05);两组患者的肥胖相关合并症均得到显著改善。结论 JI-LSG操作难度不高,简单易行,有良好的治疗肥胖症和代谢综合征的疗效,但该术式处于应用初期,需进一步研究以明确其价值。
