CAJ | 학술논문

目的探讨腹腔镜手术治疗胆总管囊肿伴有肝总管狭窄患儿的治疗方法.方法自2007年1月至2009年12月,共收治胆总管囊肿患儿41例,其中7例伴有肝总管狭窄的患儿均在腹腔镜下完成手术.采用四孔Trocars技术,先在腹腔镜下游离胆囊并将其提出腹壁外,行38 % 泛影葡胺造影,判断胆总管囊肿及肝总管的情况;电凝钩或超声刀游离切除囊肿;于脐孔处提出空肠行端侧吻合术;腹腔镜探查近端肝总管情况,将狭窄肝总管前壁向近端游离、切开、成形,并探查肝内胆管;行镜下胆肠端侧吻合术.结果 7 例胆总管囊肿伴有肝总管狭窄的患儿均在腹腔镜下完成手术,术中造影及腔镜探查证实囊肿近端肝总管狭窄,直径 1～2 mm,长度 2 mm左右,切开狭窄肝总管前壁至宽敞部,3 例伴有肝总管结石,1 例伴有蛋白栓,均游离近端肝总管行肝肠吻合.术后黄染、腹疼等症状消失,随访6个月至2年均无胆系感染或胆道梗阻发生.结论胆总管囊肿伴有肝总管狭窄的患儿在腹腔镜下行狭窄肝总管切开成形、胆肠吻合术,比开放性手术更容易操作,预后好,能够预防胆道梗阻及胆管炎的发生.
목적 탐토복강경수술치료담총관낭종반유간총관협착환인적치료방법.방법 자2007년1월지2009년12월,공수치담총관낭종환인41례,기중7례반유간총관협착적환인균재복강경하완성수술.채용사공Trocars기술,선재복강경하유리담낭병장기제출복벽외,행38 % 범영포알조영,판단담총관낭종급간총관적정황;전응구혹초성도유리절제낭종;우제공처제출공장행단측문합술;복강경탐사근단간총관정황,장협착간총관전벽향근단유리、절개、성형,병탐사간내담관;행경하담장단측문합술.결과 7 례담총관낭종반유간총관협착적환인균재복강경하완성수술,술중조영급강경탐사증실낭종근단간총관협착,직경 1～2 mm,장도 2 mm좌우,절개협착간총관전벽지관창부,3 례반유간총관결석,1 례반유단백전,균유리근단간총관행간장문합.술후황염、복동등증상소실,수방6개월지2년균무담계감염혹담도경조발생.결론 담총관낭종반유간총관협착적환인재복강경하행협착간총관절개성형、담장문합술,비개방성수술경용역조작,예후호,능구예방담도경조급담관염적발생.
Objective To study the effects of laparoscopic surgery on congenital choledochal cyst with stenosis of common hepatic duct in children patients. Methods Forty-one children patients with congenital choledochal cyst were cured from April 2001 to March 2007, including 7 cases with stenosis of common hepatic duct who underwent laparoscopic cyst excision. Four trocars were used for cholecystography with 38% diatrizoate meglumine and total resection of the gallbladder and choledochal cyst. The incision at the umbilicus was enlarged for Roux-en-Y anastomosis. The stenosis of common hepatic duct was then identified by laparoscopy. The anterior wall of stenosis was dissected and reconstructed, and then the anastomosis between proximal hepatic duct and the Roux-en-Y limb was performed. Results Laparoscopic surgery was accomplished in all of the 7 cases. The stenosis of common hepatic duct was confirmed by cholecystography and laparoscopy with 1-2 mm in diameter and 2 mm in length. After the dissection of stenosis, calculus was observed in 3 cases and embolus in 1 case. Proximal hepatic duct was used for the anastomosis. Choleplania and abdominalgia were recovered postoperatively. All cases were followed-up for 6 to 48 months and no patient was suffered from biliary inflammation and obstruction. Conclusions Compared to open surgery, laparoscopic surgery has many advantageous and can prevent biliary inflammation and obstruction. It is a better treatment for congenital choledochal cyst with stenosis of common hepatic duct in Children Patients.