腹腔镜下胆总管空肠Roux-en-Y吻合术在胆系手术中的应用

目的探讨腹腔镜下胆总管空肠Roux-en-Y吻合术在胆系疾病手术中的应用价值。方法2000年1月~2008年12月,对57例胆道疾病行此手术,包括胆总管结石伴胆总管下段严重狭窄12例,胆总管囊肿20例,胆总管炎性狭窄4例,医源性胆总管完全离断2例,上段胆管癌7例,中、下段胆管癌4例,胰头癌及壶腹癌6例,十二指肠乳头癌1例,胃癌术后腹腔转移1例。腹腔镜下切除胆囊,穿刺确认胆总管,切开胆总管约1.0 cm,置入胆道镜明确病变程度及范围,切除病灶。以腔镜直线切割缝合器离断空肠,将远端空肠与胆总管（肝总管）行端侧吻合,然后行空肠间吻合。结果57例均成功完成手术。手术时间115~230 min,（105.2±58.1）min。术中出血50~200 ml,中位数100 ml。术后住院时间4~6 d,平均5.5 d。良性疾病2例失访,36例随访5~94个月,平均49.1月,无结石复发及其他并发症。19例恶性肿瘤随访13个月~3年半,平均1.8年,16例存活1年以上,另3例于术后8、10、11个月因肿瘤死亡。结论腹腔镜下胆总管空肠Roux-en-Y吻合术是胆道疾病需行手术治疗的可行术式,但术者需具有丰富的腹腔镜手术经验。

Laparoscopic Roux-en-Y Choledochojejunostomy in the Treatment of Biliary Diseases

Objective To detect the efficacy of laparoscopic Roux-en-Y choledochojejunostomy for patients with biliary diseases.Methods From January 2000 to December of 2008,we performed Roux-en-Y choledochojejunostomy under a laparoscope on 57 patients with biliary tract diseases,including 12 cases of bile duct stone due to severe bile duct stenosis,20 cases of choledochal cyst,4 patients with inflammatory bile duct stenosis,2 patients whose bile duct was completely disarticulated due to iatrogenic causes,7 cases of upper bile duct cancer,4 cases of middle and lower bile duct cancer,6 cases of pancreatic head or ampullary carcinoma,1 patient with duodenal cancer,and 1 case of peritoneal metastasis after gastric cancer surgery.We removed the gallbladder of the patients by laparoscopic cholecystectomy and then confirmed the position of the common bile duct by puncturing.Afterwards,a 1.0-cm incision was made on the common bile to introduce a choledochoscope to detect the extent and severity of the lesion and then to resect it.After the resection,a endoscopic linear stapler was used to cut the jejunum,and the jejunum and the distal common bile duct（hepatic duct） line-side anastomosis was carried out after that.Results The procedure was successfully completed in the 57 cases with a mean operation time of（105.2±58.1） min（ranged from 115 to 230 min）.The intraoperative blood loss ranged from 50-200 ml（median,100 ml）.The patients were discharged from our hospital in 4 to 6 days（mean,5.5 days）,and then were followed up for 5 to 94 months with a mean of 49.1 months,except for two benign cases who were lost.During the follow-up,no recurrence of bile duct stones or other complications occurred.Among the cases,19 patients who had malignant tumors were followed up for 13 months to 3.5 years（mean,1.8 years）,16 of them survived for over one year after the treatment,and the other three patients died of their cancers at month 8,10,and 11 postoperation.Conclusion Laparoscopic Roux-en-Y choledochojejunostomy is feasible for biliary diseases as long as the operator is experienced in laparoscopy.