腹腔镜与开腹小儿先天胆总管囊肿穿孔T管引流术疗效比较

目的：探讨腹腔镜技术在儿童胆总管囊肿穿孔中的治疗价值。方法：12例胆总管囊肿穿孔患儿中,经腹腔镜手术治疗5例,开腹手术治疗7例,均予冲洗、置T管外引流治疗。结果：腹腔镜组手术治疗的患儿术中出血量、术后肠蠕动恢复时间、进食时间及住院时间均优于开腹手术组（P〈0.05）。结论：腹腔镜T管引流治疗儿童胆总管囊肿穿孔安全、可靠,与传统开腹术式相比创伤小、粘连少、恢复快,为二期根治术创造了良好的条件。     

腹腔镜治疗胆总管囊肿穿孔术中护理配合策略

正胆总管囊肿又称胆道扩张症,目前治疗金标准是胆总管囊肿切除、肝管空肠Roux-en-Y吻合术[1],但胆总管囊肿穿孔患儿多不能及时诊断,腹膜炎较重,手术耐受性差,开放手术多需要二期手术[2]。近年,我院为穿孔患儿采用腹腔镜下胆总管囊肿切除、胆肠吻合术,术中护理密切配合,治疗时间明显缩短,临床疗效较好,本文现总结7例胆总管囊肿穿孔患儿的术中护理经验,以探讨胆总管囊肿穿孔患儿术中护理     

腹腔镜下胆总管囊肿手术

目的　本文探讨腹腔镜下胆总管囊肿手术的可行性及其疗效。　方法　腹腔镜直视下胆道造影 ,囊肿切除及肝胆管空肠吻合 ,同时探查肝管。肠肠吻合及防返流瓣将空肠提出于腹壁外进行。随访 1～ 6个月无近期并发症。　结果　五例均一次完成手术 ,一例因既往有手术史中转开腹。　结论　腹腔镜下可完成胆总管囊肿根治手术 ,且术后恢复快 ,近期疗效满意     

先天性胆总管囊肿内引流术后癌变

文章总结了８例先天性胆总管囊肿内引流术后癌变病例。指出为防止囊肿癌变及其并发症的发生，对先天性胆总管囊肿病人应尽可能作根治性囊肿切除术和行肝管空肠ＲｏｕｘｅｎＹ吻合术，以预防胆管的癌变，对确诊为癌变病人，主张行胰十二指肠切除术。     

先天性胆总管囊肿自发破裂穿孔l例

患者 ,女性 ,1 8岁。阵发性上腹部疼痛 4 8h,以腹痛待查收住入院。入院查体 :体温正常 ,心率快 ,在 1 0 0～ 1 2 0次 /分之间 ,无皮肤及巩膜黄染 ,腹部未触及明显包块 ,全腹部压痛 ,以右上腹及右下腹为显著 ,无腹肌紧张 ,移动性浊音(± ) ,肠鸣音弱。血常规检查 :WBC:1 6 .5×     

腹腔镜胆总管囊肿根治术的手术体会及技术改进

目的 总结腹腔镜胆总管囊肿切除、肝管空肠Roux-Y吻合术的临床经验,并探讨其手术技巧和技术改进.方法 2010年11月-2012年11月,共实施腹腔镜胆总管囊肿根治术31例.采用4孔法,先游离胆囊,行胆道造影,然后扩大脐部切口提出空肠,完成Roux-Y吻合,还纳肠管后再切除囊肿,行胆肠吻合术.结果 31例患者,2例中转开腹,29例完成腹腔镜下胆总管囊肿根治术,手术时间为200 ～ 460 min,平均260 min;术后早期并发症3例(9.7％),其中胆瘘1例;术后腹壁切口出血1例;Roux-Y胆袢扭转1例.术后患儿均获得随访,随访时间为3～ 27个月,全部患儿肝功能正常,超声检查无结石形成,未见胆管狭窄及扩张.结论 腹腔镜胆总管囊肿根治术安全可靠,效果满意.     

胆总管囊肿穿孔的手术治疗

目的 探讨先天性胆总管囊肿穿孔的诊断及治疗方法。方法 对10例胆总管囊肿穿孔的临床资料进行回顾性分析。结果 男6例,女4例。平均年龄4．5岁。病程＜12h者4例,12－72h者3例,＞72h者3例。2例穿孔前合并感染,8例穿孔前无明显不适。7例行一期囊肿切除、胆道重建术,5例术后恢复顺利,2例发生吻合口漏,其中1例穿孔前合并感染,1例病程＞72h;3例先行外引流,3个月后行囊肿切除、胆道重建术。结论 胆总管囊肿穿孔如为早期且治疗及时,可一期行囊肿切除、胆道重建术。     

先天性胆总管囊肿内引流术后癌变

总结我科1980～1995年所遇8例先天性胆总管囊肿内引流术后癌变病例，对本病的发病机制、临床特点及防治进行了探讨。临床资料 全组8例，男3例，女5例，年龄25～52岁，平均38，5岁。行内引流术后至出现癌变行再手术的时间为2～18年，中间期为8，2年。原手术方式为单纯囊     

经腹腔镜行先天性胆总管囊肿根治术并发症的探讨

目的 探讨腹腔镜胆总管囊肿切除肝管空肠Roux-en-Y吻合术后并发症和预防。方法 2001年7月～2006年6月,经腹腔镜行先天性胆总管囊肿根治术66例（65例为2个月～14岁,中位数3岁9个月,另1例28岁）。囊肿型61例,直径2.5～18cm;梭形5例,直径1.2～2.2cm。其中9例合并肝门部肝管狭窄,行肝管扩大成形术。结果 66例均在腹腔镜下成功完成手术,平均手术时间3.8h（2.6～9.5h）,术后平均住院时间4.5d（3～8d）。早期并发症：胆漏2例,1例腹腔引流后自愈,另1例因腹腔引流不畅行开腹手术,术中见吻合口漏,重新吻合后愈合;1例术后7h高血钾（10.8mmol/L）心跳停止,复苏成功后于术后第3天死于肾功能衰竭;应激性溃疡2例,自行缓解。无腹腔和伤口感染。远期并发症：术后6个月突发肠梗阻1例,开腹探查见空肠肝支肠管粘连梗阻坏死,行肠切除吻合手术。无吻合口狭窄和胆管炎,65例存活者随访6～56个月,中位数21个月,行B超检查未见胆石发生,肝功能正常。结论 经腹腔镜行先天性胆总管囊肿切除肝管空肠Roux-en-Y吻合术是复杂的高风险手术,有与开腹手术类似的胆漏、应激性溃疡和肠梗阻并发症。高钾血症是该手术特殊的严重并发症,可能与长时间的CO2气腹有关,术后必须常规监测血钾变化。     

完全腹腔镜成人胆总管囊肿切除术10例分析

目的探讨完全腹腔镜胆总管囊肿切除术的技术方法与优点。方法回顾性分析2008年1月至2011年1月10例完全腹腔镜胆总管囊肿切除术患者的临床资料,所有患者均未行辅助体外肝肠吻合术。结果 10例患者均成功完成完全腹腔镜胆总管囊肿切除术。手术时间为210～300min,术后住院天数为3～7d,术后随访1～36个月,其中1例患者于术后发生吻合口狭窄,经开腹行胆肠吻合口拆除重建后,治愈出院,无死亡病例。结论完全腹腔镜胆总管囊肿切除是安全可行的,值得进一步推广。     

Early experience with laparoscopic excision of choledochal cyst in 41 children

Objective

This study aims to review our center's early experience in managing children with choledochal cysts using laparoscopic excision.

Methods

A retrospective study was carried out from the time of our first case of laparoscopic excision (2010). A total of 41 patients with choledochal cysts underwent laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy. Patient demographics, operative data, and post-operative outcomes were recorded and analyzed.

Results

Forty patients underwent the operation successfully, and the mean time of operation was 210 min (range 140 min to 380 min). One case was converted to an open operation due to dense adhesions. All patients recovered uneventfully and were discharged between seven and ten days post-operatively. Four patients suffered minor bile leaks after their operations, but they required only percutaneous drainage. The mean time for follow-up was six months (range 1 month to 1 year). No significant complication was noted during that time.

Conclusions

We successfully introduced laparoscopic excision of choledochal cyst in our center and have found this to be a safe and effective method. Long-term follow up is awaited.     

腹腔镜下肝总管-空肠改良Warren吻合术治疗小儿胆总管囊肿的效果分析

目的 探讨腹腔镜下肝总管-空肠改良Warren吻合术治疗小儿胆总管囊肿的近期效果.方法 回顾性分析昆明医科大学附属儿童医院2017年9月至2019年5月收治的77例行腹腔镜胆总管囊肿切除术患儿的临床资料.其中男15例,女62例;月龄2～163个月,中位月龄31个月;所有患儿均行腹腔镜下胆总管囊肿切除+肝总管-空肠改良W...     

小儿先天性胆总管囊肿自发性穿孔的临床分析

目的：探讨先天性胆总管囊肿自发性穿孔的诊断方法和手术方式。方法：回顾性分析16例先天性胆总管囊肿自发性穿孔患儿的临床资料。结果：本组16例患儿年龄均小于4岁，平均年龄23个月。临床表现为胆胀，腹痛，呕吐及发热，同时有全腹压痛，10例术前经腹腔穿刺明确胆道自发性穿孔的诊断，其中5例经B超或CT检查证实有胆总管囊肿，采用囊肿外引流加腹腔引流治疗。16例患儿术后均恢复良好，3个月左右再地囊肿切除加胆道重建。结论：先天性胆总管囊肿穿孔与胆道梗阻有关，对小婴儿有腹膜炎表现，全腹压痛并以右上腹为著者，应常规行腹腔穿刺检查，急诊治疗宜选择囊肿外引流术，而后再行囊肿切除和胆道重建。     

Congenital choledochal cyst and laparoscopic techniques

The authors present a 5-year-old girl with a congenital choledochal cyst and repeated cholangitis. On laparoscopy, a type I choledochal cyst of Todani classification was confirmed. The cyst was excised laparoscopically. After exteriorization of the small bowel through the umbilical incision, a Roux-en Y anastomosis was performed. Then the bowel was reintroduced into the abdominal cavity and a laparoscopic end-to-side hepaticojejunostomy was carried out. There were not intra or post operative problems. Oral food intake started at 72 hours and the patient was discharged on day 5 without complications and with excellent cosmetic results. We conclude that laparoscopic techniques are an excellent option for the resection of congenital choledochal cyst and hepaticojejunostomy in children.     

腹腔镜下结直肠癌根治术护理体会

目的探讨腹腔镜下结直肠癌根治术的护理方法。方法回顾性分析2006年4月-2009年10月我院53例腹腔镜结直肠癌根治术的临床护理资料。结果53例患者康复出院,手术时间1．5～4h,平均2．5h;术后平均2d肠功能恢复,1例术后出血,2例吻合口漏,无死亡病例发生。结论通过术前良好的心理护理、术前准备及术后并发症的观察与护理,降低并发症的发生率,进一步提升了腹腔镜治疗的优势,值得临床推广应用。     

Initial experience with complex laparoscopic biliary surgery in children: biliary atresia and choledochal cyst

Background

Laparoscopic approaches are possible for many pediatric surgical diseases, including complex biliary disorders. The authors describe their early experience with laparoscopic procedures for biliary atresia and choledochal cysts.

Methods

A retrospective review was performed with Institutional Review Board (IRB) approval of children undergoing laparoscopic Kasai portoenterostomy (n = 2) or laparoscopic excision of a choledochal cyst with Roux-en-y biliary reconstruction (n = 3). The authors report the operative technique for these procedures and present their initial results.

Results

All procedures were performed with 4 to 5 trocars using 3- and 5-mm ports. Excision of the fibrous biliary remnant (biliary atresia) or of the cyst (choledochal cysts) was performed laparoscopically in all cases. The Roux-en-y limb was created through a 1-cm extension of the umbilical port site. Laparoscopic biliary reconstruction was performed successfully in 4 of 5 patients. In one child, the proximal extent of the choledochal cyst was at the bifurcation of the hepatic duct, and the biliary reconstruction was performed via an open incision with separate anastomoses of the right and left ducts. The gallbladder was used as a handle for retraction of the liver for portal visualization, as in a cholecystectomy, and was resected at the end of the procedure. All children with choledochal cysts have normal bilirubin values. One of 2 children who underwent laparoscopic Kasai has a normal postoperative bilirubin level, whereas the other child did not drain bile and underwent a successful liver transplantation. Mean length of surgery was 338 minutes; mean length of stay was 5.5 days. There were no significant postoperative complications. Cosmesis was excellent in all cases.

Conclusions

Laparoscopic approaches for children with biliary atresia and choledochal cysts are possible. Excellent visualization of the portal structures can be achieved laparoscopically with adequate retraction of the liver. Further follow-up is needed to determine broader application.     

胆总管囊肿外引流后再手术临床分析

目的 探讨胆总管囊肿外引流及其再手术治疗。方法 回顾性总结施行Ｂ超引导下囊肿穿刺或Ｔ形管引流后再手术的胆总管囊肿病人１３例。结果 １１例行囊肿切除胆道重建术,２例行囊肿内引流术。１例术后出现胆漏并死亡。结论囊肿外引流不会使随后的囊肿切除变得复杂,对于急危重患者,宜先行囊肿外引流。