CAJ | 학술논문

目的评价腹腔镜先天性胆管扩张症根治手术的效果并探讨其并发症的防治.方法回顾2002年6月至2009年12月间65例腹腔镜胆管扩张症根治术的临床资料,分析术中和术后并发症的原因以及随访情况.结果 64例腹腔镜下顺利根治切除扩张胆总管,21例肝门胆管狭窄同时切开成形术;1例胰腺内胆总管远端囊肿因累及胰腺和十二指肠而中转开腹手术.术中或围手术期出现并发症5例,包括1例门静脉损伤、2例暂时性胆漏、1例胆支空肠袢扭转和1例应激性溃疡.随访3个月～7.5年,1例Ⅳ型复合型囊肿发生肝门吻合口狭窄.本组没有死亡率.结论 ①腹腔镜手术并发症发生率与开放手术相当,可在小儿安全实施并可取得满意效果;②为减少手术并发症应根治切除囊肿,对于常见Ⅰ型囊肿可保留肝管便于吻合,对于Ⅳ型病变应切开狭窄肝管、扩大开口斜行吻合.
목적 평개복강경선천성담관확장증근치수술적효과병탐토기병발증적방치.방법 회고2002년6월지2009년12월간65례복강경담관확장증근치술적림상자료,분석술중화술후병발증적원인이급수방정황.결과 64례복강경하순리근치절제확장담총관,21례간문담관협착동시절개성형술;1례이선내담총관원단낭종인루급이선화십이지장이중전개복수술.술중혹위수술기출현병발증5례,포괄1례문정맥손상、2례잠시성담루、1례담지공장번뉴전화1례응격성궤양.수방3개월～7.5년,1례Ⅳ형복합형낭종발생간문문합구협착.본조몰유사망솔.결론 ①복강경수술병발증발생솔여개방수술상당,가재소인안전실시병가취득만의효과;②위감소수술병발증응근치절제낭종,대우상견Ⅰ형낭종가보류간관편우문합,대우Ⅳ형병변응절개협착간관、확대개구사행문합.
Objective To retrospectively review the experience and lessons of laparoscopic surgery for congenital biliary dilatation (CBD) in children. Methods Between June 2002 and December 2009, the clinical data of 65 children who had undergone laparoscopic CBD resection at this center were retrospectively reviewed. Intraoperative and postoperative complications were recorded. All patients were followed up after discharged from the hospital. Results Patients were followed up for 3 months to 7.5 years. The total resection of CBD and the intracorporeal hepaticoenterostomy were achieved in 64 children, of which 21 patients with biliary stenosis in the porta hepatis underwent ductoplasty. The conversion of laparoscopic surgery to open surgery occurred on 1 patient due to intrapancreatic choledochocele involved pancreas and duodenum. The intraoperative or perioperative complications were noted in 5 cases including portal vein injury in 1 case, temporary bile leakage in 2 cases, a torsion of the jejunal Roux loop in 1 case and stress ulcer in 1 case. One patient with a type Ⅳ cyst developed hepaticojejunal anastomotic stricture after surgery. Conclusions Laparoscopic surgery is safe and effective for congenital biliary dilatation resection in children.