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1.
目的总结腹腔镜胆总管囊肿切除肝管空肠Roux-en-Y吻合手术经验。方法 2011年1月~2013年12月,采用腹腔镜技术治疗先天性胆总管囊肿69例,年龄2个月~14岁,平均3.5岁。三孔法12例,四孔法57例。利用右上腹trocar完成胆道造影,5 mm 30°腹腔镜下胆囊和胆总管囊肿壁全层切除;利用腹腔镜镜头探查扩张的肝内胆管;从脐部1.5 cm切口提出空肠,腹外行空肠吻合;还纳空肠肠管;经脐部切口提出横结肠,于横结肠系膜打孔上提空肠的肝支,还纳横结肠,镜下用4-0 Quill线将肝管与空肠端侧连续吻合。结果中转开腹5例,原因主要为1例肝总管无狭窄但过细,肝管分离,存在副肝管,4例囊肿巨大且囊肿炎症重尤其胰腺段过长。64例腹腔镜下完成手术,手术时间180~380 min,平均225 min,术中出血5~20 ml。术后出血2例,均经保守治疗痊愈。胆肠吻合口漏2例,经腹腔引流痊愈。2例术后2个月和6个月因系膜裂孔内疝导致肠梗阻,均急诊手术解除。其他58例腹腔镜术后恢复顺利,术后住院时间4~21 d,平均6.8 d。64例术后随访4~42个月,平均23.6月,肝功能正常,无结石和胰腺炎发生。结论腹腔镜胆总管囊肿切除肝管空肠Roux-en-Y吻合术需要严格掌握适应证,术者需要有熟练的开放手术经验和腹腔镜操作技巧,稳定的手术团队是也确保手术成功的关键。 相似文献
2.
Laparoscopic Resection Of Congenital Choledochal Cyst, Choledochojejunostomy, and extraabdominal Roux-en-Y anastomosis 总被引:2,自引:1,他引:2
Background The feasibility of laparoscopic resection of choledochal cyst and hepaticojejunostomy in children is still unclear. This report
presents the author’s experience with a first series of patients.
Methods Data from 11 consecutive children (median age 17.5 months, SD 22, range 2 to 70) with choledochal cyst scheduled for laparoscopy
were collected prospectively. There were nine type I and 2 type V cysts according to Todani’s classification. All except one
patient had intermittent jaundice or recurrent pancreatitis. The laparoscopic technique included excision of the cyst. A Roux-en-Y
anastomosis was constructed after exteriorization of the small bowel via the infraumbilical trocar incision. After repositioning
of the bowel an end-to-side hepaticojejunostomy was carried out laparoscopically.
Results The procedures were carried out in nine children without intraoperative events and a median duration of 289 min (SD 62). In
two patients, the operation was converted after 60 and 90 min due to a lack of overview at the dorsal margin with problems
in separation of the portal vein. Oral food intake was started within 2 days and tolerated well in all except one patient,
in whom biliar fluid from the drain led to laparoscopic reevaluation on day 1. A small leak was resutured and the patient
was discharged on day 5. In one patient, recurrent cholangitis and a dilated Roux-en-Y loop led to correction of some kinking
of the loop via laparotomy after 3 months. All other patients are well with bile-stained stools after a mean follow-up of
13 months.
Conclusions Laparoscopic resection of congenital choledochal cyst and choledochojejunostomy in children is feasible. We feel that there
is a considerable learning curve with the technique. Future studies will have to prove the feasibility of laparoscopic Roux-en-Y
bowel anastomosis without the need for bowel exteriorization. 相似文献
3.
背景Ⅰ型胆总管囊肿的腹腔镜手术治疗由于难度、风险大,少有中心开展。近日我们顺利完成了1例巨大Ⅰ型胆总管囊肿的全腔镜手术治疗。方法采用5孔法,囊肿的显露采用将胆囊与腹壁暂时缝合来完成,用电凝钩顺利完成囊肿的全部分离和切除。肝总管空肠重建方法如下:上提空肠,结肠前距离屈氏韧带25cm处与肝总管行端侧吻合,用4-0的可吸收线连续一层缝合。空肠袢的长度约60cm。结果手术300min,术中出血100ml,未输血。术后5d口服流质饮食,术后7d出院。结论I型胆总管巨大囊肿的全腔镜手术治疗是安全和有效的。 相似文献
4.
目的探讨胆囊管残端部分开放联合胆道造影在胆囊管结石治疗中的临床应用价值。方法2010年2月~2012年12月,对55例胆囊管结石行四孔法腹腔镜胆囊切除术。全麻,术中明确“三管”关系后夹闭胆囊管近侧端,剪开远侧部分胆囊管管壁,钝性挤压远端,挤出可能残留结石直至清亮胆汁流出,自胆囊管开放口置管行术中胆道造影,判断有无结石残留。术后观察腹部症状体征、肝功能指标,常规行B超复查,必要时行MRCP检查,明确有无胆囊管结石残留或继发胆总管结石残留。结果55例手术均获成功。术中经胆囊管残端开放钝性挤压,15例有残留小结石挤出。术中胆道造影,1例发现继发胆总管结石残留,多次反复挤压取石失败,术后第3日行ERCP+EST取石成功,余54例无结石残留。术后2例不明原因上腹疼痛,肝功能、B超及MRCP检查均无异常,予以对症解痉治疗后腹痛缓解,余均顺利康复。结论对胆囊管结石行腹腔镜胆囊切除术时,采用胆囊管残端开放法,通过钝性挤压胆汁溢出,冲出可能残留结石,辅以经胆囊管残端插管胆道造影,及早发现胆囊管结石残留或继发胆总管结石残留,增加腹腔镜胆囊切除术的安全性。 相似文献
5.
腹腔镜肝管空肠Roux-en-Y吻合术治疗52例3岁以内婴幼儿先天性胆总管囊肿 总被引:3,自引:0,他引:3
目的探讨腹腔镜辅助肝管空肠Roux-en-Y吻合术治疗3岁以内婴幼儿先天性胆总管囊肿的疗效。方法2001年4月~2007年3月,采用腹腔镜技术治疗3岁以内婴幼儿先天性胆总管囊肿52例,其中囊状扩张44例,梭形扩张8例。12例(23%)患儿合并肝门部肝管狭窄,行肝管扩大成形术;采用四孔技术和3~5 mm手术器械完成胆道造影、胆囊和胆总管囊肿壁全层彻底切除;延长脐部切口提出空肠,直视下行Roux—en—Y空肠吻合,然后还纳肠管;经结肠后上提空肠的肝支,镜下将肝管与空肠连续吻合。结果52例在腹腔镜下完成手术,无中转开放手术,平均手术时间226 min(160~455 min),手术中出血量5~10 ml,无手术中需要输血者。1例肝门胆管狭窄的患儿术后胆漏,持续腹腔引流26 d,自然愈合。术后1~2 d进食,无并发症患儿住院3~6 d。52例术后随访3~72个月,平均32.6月,肝功能正常,无并发胆管狭窄和胆管炎,无结石和胰腺炎发生。结论腹腔镜胆总管囊肿彻底切除肝管空肠Roux—en—Y吻合手术治疗3岁以内婴幼儿先天性胆总管囊肿安全、可靠,镜下放大的手术视野有利于精确的手术操作。 相似文献
6.
7.
A case of a nasoplatine duct cyst in a 41-year-old male is reviewed. The typical radiologic and histologic findings are presented. 相似文献
8.
An isolated cyst of the cystic duct is an extremely rare lesion. Only single case reports are documented in the literature.
The most accepted classification system of biliary cysts, the Todani classification, does not include this lesion. We report
a case of isolated cyst of the cystic duct. The initial referral was for evaluation of a gallbladder mass discovered during
evaluation of abdominal pain. Preoperative diagnosis was challenging as multiple imaging studies were unable to differentiate
this lesion from a choledochal cyst. Surgical planning thus included cyst excision and biliary reconstruction. Operative exploration
revealed a type VI biliary cyst and cholecystectomy with cystic duct ligation near the common bile duct was curative. 相似文献
9.
外固定肝脏拉钩在腹腔镜下胆总管囊肿切除和胆道重建术中的应用 总被引:1,自引:0,他引:1
目的探讨外固定肝脏拉钩在腹腔镜下胆总管囊肿切除和胆道重建术的应用价值。方法采用四孔加外置入Nathanson肝脏拉钩外固定技术,腹腔镜下行胆总管囊肿切除、Roux-en-Y胆道重建术。结果20例患儿手术全部成功,无中转开腹手术,无死亡。1例合并美克尔憩室,经脐部拔出后切除;3例患儿应家长要求同时切除阑尾。手术时间3~5.5h(平均3.5h);术中出血量10~30ml。1例胆漏。术后住院时间6~9d(平均6d)。20例术后随访3~30个月(平均14个月),无肠粘连梗阻和吻合口狭窄发生。结论利用外固定肝脏拉钩的牵引可以扩大腹腔空间,便于腹腔镜下操作。 相似文献
10.
胆囊管结扎夹闭法在腹腔镜胆囊切除术中处理粗大胆囊管的应用体会(附104例报告) 总被引:1,自引:0,他引:1
目的探讨胆囊管结扎夹闭技术在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中处理粗大胆囊管的应用价值。方法 2007年6月~2010年12月,104例LC术中发现粗大胆囊管(直径>0.8 cm),先用丝线结扎使之变细,再用钛夹完全夹闭处理。结果 104例术中胆囊管直径0.8~1.2 cm,手术均获成功,无中转开腹。手术时间40~150 min,平均95 min。无出血、胆漏和腹腔感染等并发症。84例随访3个月~3年,平均1.7年,无腹痛、黄疸及发热等症状。结论对粗大胆囊管先结扎后夹闭的处理方法安全,可靠,成本低廉,特别适合于经济条件相对较差的基层医院应用。 相似文献
11.
腹腔镜胆囊切除术胆管损伤的处理 总被引:1,自引:0,他引:1
目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中胆管损伤的处理。方法回顾分析我院1992年3月-2006年10月8876例LC中16例胆管损伤的临床资料,其中胆总管横行剪断4例,电灼伤3例,胆总管部分撕裂伤4例,钛夹误夹5例。胆管裂口修补,T管支撑引流6例;游离两断端,行端端吻合,T管支撑引流3例;胆管空肠Roux—en—Y吻合5例;去肽夹2例。结果1例胆总管横行剪断后行胆管端端吻合,置T管支撑引流3个月,T管拔除3~5个月后因胆管狭窄,再次行胆管空肠Roux—en—Y吻合,术后未出现因胆管狭窄所引起阻塞性黄疸。2例因胆管空肠吻合口狭窄,分别于术后9、11个月再次行胆管空肠Roux—en—Y吻合,再手术后随访2~4年,未出现胆管炎症状、结石再形成。1例胆管完全性夹闭后行胆管空肠Roux—en-Y吻合术后胆道感染,反复发作。余12例均一次性临床治愈,其中10例随访3~4年,未出现任何不适。结论胆管损伤是LC的主要并发症,早期预防和积极处理胆管损伤是防止多次胆道手术的重要举措。 相似文献
12.
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 4½ 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. 相似文献
13.
目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中胆囊动脉出血的原因、预防及处理心得。方法 2000年2月~2012年8月实施LC 11 886例,其中146例(1.2%)术中发生胆囊动脉不同程度出血,通过钛夹夹闭、电灼、压迫止血。结果 144例成功完成LC,手术时间30~90 min,平均48 min;术中出血量200~500 ml,平均325 ml;无输血。中转开腹2例,1例胆囊动脉主干回缩至肝总管后方,无法施夹;1例合并肝硬化,胆囊床广泛渗血不止,系损伤肝中静脉的属支。146例术后随访3~6个月,平均4个月,未出现肝内外胆管损伤、继发出血、腹腔感染、肠梗阻等严重并发症。结论 LC术中胆囊动脉出血重在预防,一旦发生出血,应沉着、冷静,只要解剖结构熟悉,操作技术娴熟,选择合理的止血方法,胆囊动脉出血均能获得满意效果。 相似文献
14.
Li L Liu SL Hou WY Cui L Liu XL Jun Z Liu-Ming H Gang L Kamal NA 《Journal of pediatric surgery》2008,43(4):644-646
Background/Purposes
Laparoscopy has been widely accepted as a technique for the excision of choledochal cyst, but there has been little experience using it as a therapeutic modality for hepatic duct stenosis. The aim of this study is to present our experiences in laparoscopic excision of biliary stenosis and Roux-en-Y reconstruction for patients with choledochal cysts.Methods
Eight patients, 3 boys and 5 girls (ranged from 6 months to 12 years; median age, 3.6 years), with hepatic duct stenosis underwent laparoscopic excision of the cyst and ductoplasty, with a Roux-en-Y hepaticoenterostomy between July 2001 and January 2005. Seven of the 8 patients had common hepatic duct stenosis with intrahepatic duct dilatation, and 1 had right hepatic duct stenosis with proximal dilatation.Four ports were inserted for instruments of 3- and 5-mm sizes. Each patient underwent a laparoscopic cholangiography. The gallbladder and dilated bile ducts were completely excised. The strictures of the hepatic ducts were treated by ductoplasty. The cut end of the duct was widened by incising along the anterior wall of the hepatic duct after excision of the narrow segment. By using intraoperative bile duct endoscopy, the optimal level of resection of the common hepatic duct was determined safely without endangering the orifices of the hepatic ducts or leaving any redundant duct, and the stone debris in the bile duct was identified and washed out. The Roux-en-Y jejunal loop was fashioned extracorporeally by exteriorizing the jejunum through the umbilical incision (1.0-1.5 cm) and passed up retrocolically followed by an end-to-side hepaticojejunostomy.Results
The median duration of the operation was 4.3 hours (3.8-5.6 hours). Intraoperative bleeding was minimal, with no patients requiring blood transfusion. In 7 of the 8 cases, postoperative hospital stay ranged from 4 to 6 days; the other case had bile leak, which was cured by draining for 26 days without surgical intervention. All the patients had been followed up for 6 to 51 months. They stayed asymptomatic and well with no delayed complication.Conclusions
Laparoscopically assisted hepatic ductoplasty is effective and safe for children with choledochal cyst. Bile duct endoscopy proved to be a valuable instrument in showing detailed variations of the biliary system and allowed a safe hepatic hilum exploration and accurate placed hepaticojejunal anastomosis. 相似文献15.
D. Van den Bussche E. Audenaert G. De Gendt L. Proot H. Devriendt 《Acta chirurgica Belgica》2013,113(1):67-69
Cysts of the thoracic duct are uncommon entities that can occur in the abdominal segment, the cisterna chyli, the thoracic segment and the cervical segment of the thoracic duct. The rarest presentation is in the cervical segment, with only seventeen cases reported in English literature.The diagnosis can be made by puncture and with the use of computed tomography or ultrasonography. The cystic fluid always contains an excess of T-lymphocytes and triglycerides. Except for two cases, all reported cervical thoracic duct cysts were surgically treated by excision and ligation of the lymphatics connected to the cyst.We present a case of a successful non-operative treatment of a cervical thoracic duct cyst that was resolved by repeated aspiration and dietary changes only. 相似文献
16.
Parissa Tabrizian Peter S. Midulla 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2010,14(2):272-274
Benign congenital liver cysts are rare in the pediatric population and often present a challenge in the diagnosis. Therefore, with recent advances in the field of minimally invasive surgery, this technique may be ideal in achieving both diagnosis and curative resection. We describe the case of a 2-month-old female initially referred for an antenatal ultrasound in the third trimester revealing a 7-cm intraabdominal cystic lesion of unknown origin. She was found to have a 10-cm hepatic cyst successfully treated by laparoscopic surgery. Our approach consisted of complete cyst excision along with its attached hepatic parenchyma. We recommend this technique as safe and feasible. 相似文献
17.
Papillary carcinoma arising in a thyroglossal duct cyst is a rare tumor. We report the case of 64-year-old man treated for thyroglossal duct cyst. Preoperatively, the thyroid gland was normal on physical examination and imaging studies. The Sistrunk procedure was done. The histopathological examination revealed thyroid papillary carcinoma. Postoperatively thyroid hormon was given to suppress serum TSH levels and the patient was followed at regular intervals. During a 5-year follow-up period, no recurrence of the disease occured. 相似文献
18.
目的:探讨腹腔镜经胆囊管治疗胆总管结石的疗效。方法我院2006年6月~2013年10月腹腔镜下经胆囊管治疗胆总管结石36例,分离胆囊管至近胆总管处,Hem-o-lok结扎胆囊管近端,横行剪开胆囊管远端1/2~2/3周径,置入胆道镜。结果手术时间45~110 min,平均77 min;术后住院时间3~5 d,平均4.2 d。均无胆漏,无胆道残余结石发生。36例随访2~24个月,平均15个月,无上腹部疼痛症状,无结石复发。结论腹腔镜经胆囊管胆道探查取石术治疗胆总管结石创伤小、恢复快,具有很好的临床应用价值。 相似文献
19.
腹腔镜胆总管囊肿根治切除、肝管空肠吻合术 总被引:3,自引:1,他引:3
目的:探讨腹腔镜下胆道造影和胆总管囊肿根治切除、肝管空肠吻合术的可行性。方法:34例先天性胆总管囊肿患者行腹腔镜下胆道造影,胆囊和囊状胆管完全切除,经脐孔提出空肠行Roux-en-Y吻合和体内肝管空肠吻合手术。结果:胆道造影显示胆管囊状扩张24例,梭形扩张10例。33例腹腔镜下顺利完成手术,手术时间平均4.2h(3.5~6.5h);1例胰腺内胆总管远段囊肿中转开腹手术。4例合并肝管狭窄同时行胆管成形术。术后5~7d患者痊愈出院。31例获得随访,5~40个月未发生术后并发症。结论:腹腔镜下胆道造影简便实用,对指导镜下根治切除囊肿,避免损伤胆胰管连接部和处理肝内胆管狭窄有重要参考价值。 相似文献
20.
《Scandinavian cardiovascular journal : SCJ》2013,47(3-4):175-177
A mediastinal thoracic duct cyst was incidentally found in an asymptomatic 45-year-old man. The cyst, 6 cm in diameter, was soft and unilocular, with an extremely thin wall, and contained chyle. It was successfully excised. 相似文献