腹腔镜在先天性胆管扩张症中的应用

目的：总结腹腔镜手术诊治先天性胆管扩张症（congenital biliary dilatation,CBD）的经验,评价腹腔镜肝外扩张胆管切除、肝管空肠吻合术的可行性及安全性。方法：回顾2002~2010年腹腔镜手术治疗106例CBD患者的临床资料,分析其手术技术、围手术期并发症及随访情况。结果：62例胆总管呈囊状扩张、44例呈梭形扩张。其中,83例行术中胆道造影,77例显示胰胆管合流异常。103例成功完成腹腔镜手术,3例中转开腹,其中1例囊肿巨大,1例Ⅲ型囊肿损伤十二指肠,1例合并炎性血管瘤出血。24例伴有肝内胆管局限性扩张（IV-A型）同时行肝门胆管狭窄段切开或切除扩大成形术。手术时间平均（214.9±58.3）min,术后平均住院（7.7±2.3）d。围手术期发生并发症8例,1例术中门静脉损伤,5例暂时性胆漏,1例胆支空肠袢扭转,1例应激性溃疡。随访6个月~8年,1例发生肝门吻合口狭窄行二次手术解除,1例术后切口疝经手术修复,2例肠梗阻经保守治疗后缓解。余者恢复良好。结论：腹腔镜术中胆胰管造影可确定CBD类型及胆胰管合流情况,腹腔镜提供的视野放大效果有助于根除病变、避免损伤胆胰管连接部和矫治肝门胆管狭窄,腹腔镜手术可安全地施行并取得满意效果。

Laparoscopic surgery for congenital biliary dilatation

Objective:To summarize the experiences of laparoscopic surgery for congenital biliary dilatation(CBD),and evaluate the feasibility and safety of laparoscopic excision of dilated extrahepatic duct and hepatojejunostomy.Methods:The clinical data of 106 patients with CBD underwent laparoscopic procedure were retrospectively reviewed from 2002 to 2010.The surgical techniques,perioperative complications and follow-up problems were analyzed.Results:Of them,62 cases manifested choledochal cystic dilation and 44 ca...