腹腔镜胆总管囊肿根治切除、肝管空肠吻合术

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。

Laparoscopic radical resection for congenital choledochal cyst and Roux-en-Y hepaticojejunostomy

Objective:To explore the feasibility of intraoperative cholangiography and radical resection of choledochal cyst with hepaticojejunostomy by laparoscopy.Methods:Under laparoscopic guidance,34 cases of congenital choledochal cyst undergone an intraoperative cholangiography,the gallbladder and the cystic choledochus were excised completely,Roux-en-Y anastomosis was constructed after exteriorization of the jejunum via the umbilical trocar incision.After repositioning of the bowel an end-to-side hepaticojejunostomy was carried out intracorporeally by the hand suture.Results:There were 24 cystic and 10 fusiform dilatations according to cholangiography.These procedures were performed in 33 patients without intraoperative events with a median duration of 4.2 hours(range from 3.5 to 6.5 hours).One conversion was necessitated due to intrapancreatic choledochocele.4 cases with intrahepatic ductal stenoses underwent the duct plasty concomitantly.Hospitalization ranged from 5 to 7 days after the procedure.There was no postoperative complication during a follow up period from 5 to 40 months.Conclusions:Laparoscopic cholangiography is a simple and valuable method,which can directe laparoscopic resection of total choledochal cysts,to prevent the union injury and treat stenosis of the intrahepatic bile ducts.