CAJ | 학술논문

目的本研究对腹腔镜胆总管囊肿切除肝管空肠Roux-en-Y吻合手术6年经验进行总结,探讨该技术的近期和远期疗效.方法从2001年4月至2007年3月,本课题组采用腹腔镜技术治疗先天性胆总管囊肿患儿102例,平均年龄3.2岁.其中13～28d9例,29d～6个月23例,7个月～3岁28例,4～18岁42例.采用四trocars技术完成胆道造影、胆囊和胆总管囊肿壁全层切除;同时利用腹腔镜头对扩张的肝内胆管进行探查;从脐部切口提出空肠,直视下行Roux-en-Y空肠吻合,然后还纳肠管;经结肠后上提空肠的肝支,镜下将肝管与空肠连续吻合.结果 102例全部在腹腔镜下完成手术,无中转开放手术者,平均手术时间224min(155～456min),手术中出血5～10ml,无手术中需要输血者.21例患儿合并肝门部肝管狭窄,行肝管扩大成形术;其中1例患儿手术后并发胆漏,持续腹腔引流26d,自然愈合.2例患儿分别于手术后第二天至第五天和第七天并发消化道出血.1例5岁女孩手术后7.5h突发心跳骤停,高血钾(K+10.85mmol/L),死亡.其他98例患儿手术后恢复顺利,手术后3～6d出院.1例患儿于手术后6个月发生空肠肝支梗阻坏死,行坏死肠管切除,二次肝管空肠Roux-Y吻合手术.患儿手术后经3～72个月的随访肝功能正常,无结石和胰腺炎发生.结论腹腔镜胆总管囊肿切除肝管空肠Roux-en-Y吻合手术是治疗先天性胆总管囊肿可靠的手段,镜下放大的手术视野有利于精确的手术操作,近期和远期疗效良好.手术后早期有必要密切观察血钾的变化.
목적 본연구대복강경담총관낭종절제간관공장Roux-en-Y문합수술6년경험진행총결,탐토해기술적근기화원기료효.방법 종2001년4월지2007년3월,본과제조채용복강경기술치료선천성담총관낭종환인102례,평균년령3.2세.기중13～28d9례,29d～6개월23례,7개월～3세28례,4～18세42례.채용사trocars기술완성담도조영、담낭화담총관낭종벽전층절제;동시이용복강경두대확장적간내담관진행탐사;종제부절구제출공장,직시하행Roux-en-Y공장문합,연후환납장관;경결장후상제공장적간지,경하장간관여공장련속문합.결과 102례전부재복강경하완성수술,무중전개방수술자,평균수술시간224min(155～456min),수술중출혈5～10ml,무수술중수요수혈자.21례환인합병간문부간관협착,행간관확대성형술;기중1례환인수술후병발담루,지속복강인류26d,자연유합.2례환인분별우수술후제이천지제오천화제칠천병발소화도출혈.1례5세녀해수술후7.5h돌발심도취정,고혈갑(K+10.85mmol/L),사망.기타98례환인수술후회복순리,수술후3～6d출원.1례환인우수술후6개월발생공장간지경조배사,행배사장관절제,이차간관공장Roux-Y문합수술.환인수술후경3～72개월적수방간공능정상,무결석화이선염발생.결론 복강경담총관낭종절제간관공장Roux-en-Y문합수술시치료선천성담총관낭종가고적수단,경하방대적수술시야유리우정학적수술조작,근기화원기료효량호.수술후조기유필요밀절관찰혈갑적변화.
Objective To review our experience in laparoscopic total cyst excision with Roux-Y hepatoenterostomy for choledochal cyst in children. Methods Between April 2001 and March 2007, laparoscopic cyst excision with Roux-Y hepatoenterostomy was performed on 102 children with choledochal cyst in two pediatric surgery centers in Beijing. Their age ranged from 13 days to 18 years (average age 3.2 years). All cases were performed with four trocars plus the scope. The gallbladder and the dilated bile duct were completely excised, and intrahapic bile duets were also examined for stone debris and ductal stenosis. Laparoscopic cyst excision and ductoplasty was performed if the patient was associated with hepatic ductal stenosis. After exteriorization of the small bowel through the umbilical incision (1 to 1.5 cm), a Roux-en Y anastomosis was performed. Then the bowel was reintroduced into the abdominal cavity and a laparoscopic end-to-side hepaticojejunostomy was carried out by continuous hand suture methods between the stump of the hepatic duct and Roux-en-Y limb. Results All patients were performed laparoscopically without conversion. Average operative time was 224 min (155-456 rain). Intraoperative bleeding volume was 5 to 10 ml Twenty-one patients were performed laparoscopic cyst excision and ductoplasty. Bile leak occurred in 1 of the 21 cases on the first day after operation, and was cured after 26 days drainage GI bleeding occurred in 2 cases, one was from day 2 to day 5 and the other was on day 7. Both of them were cured after anti-acid therapy. One five-years-old girl died of hyperkalemia at 7.5 hours after operation. The other 98 patients were recovered without any complications, and their hospital stay ranged from 3 to 6 days after the operation. All of the patients had been followed up for up to six years. One patient suffered Roux-Y limb intestinal obstruction at the sixth month after operation, and underwent intestine resection and the jejunal limb re-anatomosis. Conclusions Laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy is a feasible, safe and effective option for the resection of congenital choledochal cyst in children.