完全腹腔镜下胆肠Roux-en-Y吻合术的应用：附25例报告

目的:探讨和总结完全腹腔镜下胆肠Roux-en-Y吻合术的手术技巧及技术改进。方法:回顾性分析2011年10月—2014年10月期间行改良完全腹腔镜下胆肠Roux-en-Y吻合术的25例患者临床资料。其中先天性胆总管囊肿(I型)10例,胆总管结石合并下段炎性狭窄2例,胰头癌6例,胆总管下端癌5例,壶腹周围癌2例。结果:全组患者均成功完成手术,无中转开腹。先天性胆总管囊肿手术时间(194.5±20)min,炎性狭窄及恶性肿瘤导致梗阻性黄疸手术时间(120±23.5)min;胆管空肠吻合时间为(18.4±3.3)min,空肠空肠吻合时间为(17.4±2.3)min;平均术中出血(38.8±35.8)m L,下床活动时间(2.0±0.9)d,排气时间(2.48±0.7)d,术后住院时间(7.96±1.9)d。术后1例发生少量胆汁漏,经延长腹腔引流时间痊愈。24例(96.0%)获得随访1~36个月,1例患者术后出现反流性胆管炎,经抗感染等治疗后痊愈;所有患者均未出现黄疸复发。结论:完全腹腔镜下胆肠Roux-en-Y吻合术是安全、有效、可行的,通过技术改进,能降低手术难度,简化手术流程,缩短手术时间。

Application of modified totally laparoscopic Roux-en-Y hepaticojejunostomy: a report of 25 cases

Objective: To investigate and discuss the surgical practice and technical improvement of totally laparoscopic Roux-en-Y hepaticojejunostomy. Methods: The clinical data of 25 patients undergoing modified totally laparoscopic Roux-en-Y hepaticojejunostomy between October 2011 and October 2014 were retrospectively analyzed. Of the patients, 10 cases were congenital choledochal cysts (type I), 2 cases were common bile duct stone with distal inflammatory stricture, 6 cases were cancer in the head of the pancreas, 5 cases were distal bile duct cancer, and 2 cases were periampullary cancer. Results: Operation was successfully completed in all patients, with no need for open conversion. The operative time for choledochal cysts was (194.5±20) min and for obstructive jaundice caused by inflammatory stricture or tumors was (120±23.5) min; the time for hepaticojejunal anastomosis was (18.4±3.3) min and for jejunojejunal anastomosis was (17.4±2.3) min; the intraoperative blood loss was (38.8±35.8) mL, time to ambulation was (2.0±0.9) d and to first flatus was (2.48±0.7) d, and the length of postoperative hospital stay was (7.96±1.9) d, respectively. Minor bile leakage occurred in one patient after operation, which ceased after prolonged drainage. Follow-up was obtained in 24 patients (96%) for 1-36 months, postoperative reflux cholangitis occurred in one patient, which was resolved by anti-infective treatment, and no relapse of jaundice was noted in any of the cases. Conclusion: Totally laparoscopic Roux-en-Y hepaticojejunostomy is safe, effective, and feasible, and technical improvement can reduce the surgical difficulty, simplify the surgical procedure and shorten the operative time.