腹腔镜胰管空肠吻合术治疗小儿胰管扩张的探讨

目的 将腹腔镜胰管空肠吻合术应用于小儿胰管扩张的治疗,探讨其可行性和有效性.方法 2009年7月至2010年8月,3例患儿因反复发作的胰腺炎,影像学检查发现胰管扩张来我院就诊,对其采用腹腔镜胰管空肠吻合术进行治疗.术中进行胆道造影和胰管穿刺造影,明确胆道和胰腺胰管的解剖结构.在胰管显影示胰管扩张部纵形劈开胰管,发现胰管内蛋白栓存在,将其清除.距Treitz韧带5 cm处提取空肠10～15 cm,将其经脐部切口拉出,行空肠-空肠Roux-Y吻合,还纳腹腔.将空肠Roux-Y支经结肠后提至小网膜囊,在系膜缘的对侧切开空肠,用5-0 PDS线将其与胰管行侧侧吻合.术后对所有患儿进行跟踪随访.结果 所有患儿手术过程顺利,手术时间为103～154min,术中出血较少,未进行输血.术后患儿腹痛症状消失,术后住院时间为4～6 d.术后未有胰漏等并发症发生.迄今为止随访9～22个月,随访发现患儿血淀粉酶恢复正常,未再发生腹痛、呕吐等胰腺炎症状,B超和CT检查未发现胰腺异常.结论 腹腔镜胰管空肠吻合术是治疗伴胰管扩张的小儿反复发作性胰腺炎的安全而有效的治疗方法,值得推广应用.

Laparoscopic pancreaticojejunostomy for pancreatic ductal dilatation in children

Objective To explore the laparoscopic pancreaticojejunostomy in children with pancreatic ductal dilatation.Methods Three children with recurrent pancreatitis and pancreatic ductal dilatation underwent laparoscopic pancreaticojejunostomy between July 2009 and August 2010.Following longitudinal splitting the dilated pancreatic ducts,a side-to-side Roux-Y pancreaticojejunostomy was performed.Results The operation time ranged from 103 to 154 min,and blood loss was minimal without necessity for blood transfusion.The hospital stay period after the operation was 4 to 6 days.Pancreatic juice leakage did not happen in all cases.All the patients had been followed up and no pancreatitis recurrence could be noted.Conclusions Laparoscopic pancreaticojejunostomy for children with pancreatic duetal dilatation is safe and effective.