腹腔镜下应用超声刀行胆总管囊肿切除术

目的：探讨腹腔镜下应用超声刀行胆总管囊肿切除、肝管空肠Roux—Y吻合术的操作技术及优越性。方法：本组45例患儿在腹腔镜下应用超声刀行胆总管囊肿切除,胆道重建术。首先在腹腔镜监视下行胆囊穿刺造影,切除胆囊。然后用超声刀横断囊肿,近端游离至肝总管处切断,远端游离至胰胆管汇合处结扎切断,彻底切除囊肿壁。经脐部2cm切口提出空肠于腹壁外行空肠Roux-Y吻合,肝支30～35cm,然后将肠管送回腹腔经结肠后将肝支拉至肝下,将肝管与空肠端侧吻合。结果：45例患儿均在腹腔镜下应用超声刀完成胆总管囊肿切除、肝管空肠Roux—Y吻合术。手术时间3．5～6．0h(平均4．2h)。术中出血量10～50ml(平均15ml)。全部患儿无术中并发症。术后住院时间3～9d(平均5．5d)。38例获随访,随访时间1个月～1．5年,无吻合口狭窄及粘连性肠梗阻发生,肝功能检查正常。结论腹腔镜下应用超声刀行胆总管囊肿切除、肝管空肠Roux—Y吻合术安全可靠。优点为手术视野清晰,解剖层次清楚,术中出血少、创伤小,术后疼痛轻、切口小,手术瘢痕不明显。

Total cyst excision with ultrasonic scalpel under the laparoscope for choledochal cyst

Objective To discuss the technique and its advantage on application of ultrasonic scalpel in laproscopic cyst excision with Roux en Y hepatoenterostomy. Methods Forty five cases were undergone laparoscopic cyst excision with Roux en Y hepatoenterostomy by ultrasonic scalpel. After intraoperative cholangiogram, the gallbladder and the dilated bile duct were completely excised by ultrasonic scalpel. Roux en Y hepatoenterostomy was performed extracorporeally through umbilical incision, then an end to side anastomosis was carried out intracorporeally. Results All 45 cases were completely accomplished under laparoscope combined with ultrasonic scalpel.Median duration of operation was 4 2 h(3 5-6 0 h).Intraoperative bleeding was between 10-50 ml (median 15 ml).No complication were found during operation. All children were discharged in 3-9 d (median 5 5 d)after operation.Thirty eight cases were followed up 1-18 months.No stenosis or ileus occurred.Liver functions were in normal level. Conclusions Total cyst excision with Roux en Y hepatoenterostomy by ultrasonic scalpel under the laparoscope was effective and safe for choledochal cyst.The most excellence was that clearly viewing during operation,less bleeding and injury,free of pain postoperation,microincision and scar.