腹腔镜肝门肠吻合术治疗胆道闭锁的探讨(12例报告)

目的:探讨经腹腔镜辅助行肝门解剖和肝门肠吻合术治疗先天性胆道闭锁的临床效果。方法:先天性胆道闭锁患儿12例,29~87d11例,5.5个月1例。2例为肝总管闭锁(Ⅱ型),肝门部有直径1.2~2.5cm囊肿与肝内胆管相通;10例为肝门部胆管闭锁(Ⅲ型)。于脐部纵切口置入10mmTrocar,然后分别于右上腹、右中腹和左上腹置入3个5mmTrocar。术中胆道造影,确诊为胆道闭锁,暴露肝门;切除胆囊,游离切除肝门纤维块,空肠行Roux-en-Y吻合术保留肝支30~35cm,然后将肠管送回腹腔,将空肠肝支经结肠后拉至肝门下;用5-0可吸收缝线将空肠与肝门端侧连续吻合。结果:本组12例患儿中1例因肝门渗血中转开腹手术;另11例均在腹腔镜辅助下完成手术,手术时间平均为3.5h(3.1~4.6h),出血量约10ml,没有需在术中和术后输血者,全组患儿无手术后肠粘连梗阻和腹腔感染。结论:经腹腔镜行肝门肠吻合术治疗先天性胆道闭锁安全可靠,具有暴露肝门清晰、肝门纤维块分离和切除准确、对患儿打击小等优点。

Laparoscopic porto-enterostomy for biliary atresia: a report of 12 cases

Objective: To investigate the effect of laparoscopic portoenterostomy for biliary atresia.Methods:Twelve patients with biliary atresia aged from 37 to 87d in 11 and 5.5m in one underwent laparoscopic hilar dissection and portoenterostomy,in which, ween two of the 12 patients associated with type biliary atresia and the other ten with type . Laparoscopic hilar dissection and portoenterostomy was accomplished with four trocars. The umbilical site was used for extracorporeal RouxenY enteroenterostomy.Results:Of the 12 patients,1 converted to open surgery because of hilar oozing,11 were successfully carried out laparoscopic portoenterostomy.Median duration of the operation was 3.5h (3.1 to 4.6h),intraoperative bleeding was about 10 ml without necessity for blood transfusion. one 5.5monthold patient with type biliary atresia died of liver failure at the 28_(th) day after operation. The other five patients showed signs of adequate bile flow, such as pigmented stools, and disappearance of jaundice. Two cases With type biliary atresia had episode of cholangitis. Five cases had been followed up for 3 to 20 months with good liver function.Conclusions: Laparoscopic hilar dissection and portoenterostomy for biliary atresia is effective and safe.our result is surprisingly good, but its real value will be known after more clinical observations.