腹腔镜下先天性胆总管囊肿切除、肝管-空肠吻合术以及腹腔外罗克逊-“Y”形吻合术

作报道1例3月龄先天性胆总管囊肿患，直至治疗都无症状。腹腔镜检查证实Ⅰ型先天性胆总管囊肿的诊断，并实施了切除。经由脐下套针切口将小肠外置后进行罗克逊-“Y”形吻合术。腹腔镜下行肝管-空肠端侧吻合术。手术耗时4．5h，术中未出现不良情况。术后第2天患儿开始经口进食，顺利耐受胆汁性粪便。术后第8天出现肠梗阻症状。小切口开腹探查发现罗克逊-“Y”形吻合处与结肠系膜粘连导致梗阻。实施袢环松解术，术后恢复过程平稳。作推论：目前认为先天性胆总管囊肿切除术和胆总管空肠吻合术适用于低龄患。然而，与传统的手术一样，当小肠外置用于肝管-空肠罗克逊-“Y”形吻合术时，粘连性小肠梗阻也可能发生。

Laparoscopic resection of congenital choledochal cyst, hepaticojejunostomy, and externally made Roux-en- Y anastomosis

The authors present a 3- month-old patient with a congenital choledochal cyst, which was asymptomatic until treatment. On laparosco confirmed and excised py, a type I choledochal cyst was 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 intraopera- tive 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 uneventcholedochal 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.