CAJ | 학술논문

目的探讨腹腔镜胆总管囊肿切除肝总管空肠Roux-en-Y吻合术围手术期并发症的发生及防治.方法回顾性分析2012年3月至2013年1 1月,经腹腔镜行先天性胆总管囊肿根治术78例的临床资料.其中,男9例,女69例;囊肿型61例,梭形17例.结果 78例患儿均在腹腔镜下成功完成手术.手术时间2.5～5.5 h,平均3.5h.术中发生右肝管损伤1例,左右肝管分离1例,胆囊动脉变异出血1例均在术中判断明确并及时处理,未产生不良后果.术后发生出血2例,胆漏2例,胆肠吻合口狭窄1例,术后胰腺炎1例,胆囊窝或膈下包裹性积液2例,此8例中,再次手术2例,1例为大出血,再次剖腹探查止血;1例为胆肠吻合狭窄再次行腹腔镜下胆肠吻合术.术后胆漏2例,1例腹腔引流后术后3周自愈;另1例因腹腔引流不畅术后10d肝下出现包裹性积液行穿刺引流.术后胰腺炎1例,术后1周突发腹痛,查血淀粉酶明显升高,提示胰腺炎,予以禁食及经鼻孔空肠喂养管置入后予以空肠喂养4周后痊愈.78例患儿均或随访,随访时间3～22个月,均行肝功能及B型超声检查,3例出现肝内高密度钙化影,肝功能均正常.结论腹腔镜行先天性胆总管囊肿切除肝总管空肠Roux-en-Y吻合术是复杂的高风险手术,需要娴熟的腹腔镜技术和技巧,术中仔细、精准处理有利于减少术中、术后并发症的发生.
목적 탐토복강경담총관낭종절제간총관공장Roux-en-Y문합술위수술기병발증적발생급방치.방법 회고성분석2012년3월지2013년1 1월,경복강경행선천성담총관낭종근치술78례적림상자료.기중,남9례,녀69례;낭종형61례,사형17례.결과 78례환인균재복강경하성공완성수술.수술시간2.5～5.5 h,평균3.5h.술중발생우간관손상1례,좌우간관분리1례,담낭동맥변이출혈1례균재술중판단명학병급시처리,미산생불량후과.술후발생출혈2례,담루2례,담장문합구협착1례,술후이선염1례,담낭와혹격하포과성적액2례,차8례중,재차수술2례,1례위대출혈,재차부복탐사지혈;1례위담장문합협착재차행복강경하담장문합술.술후담루2례,1례복강인류후술후3주자유;령1례인복강인류불창술후10d간하출현포과성적액행천자인류.술후이선염1례,술후1주돌발복통,사혈정분매명현승고,제시이선염,여이금식급경비공공장위양관치입후여이공장위양4주후전유.78례환인균혹수방,수방시간3～22개월,균행간공능급B형초성검사,3례출현간내고밀도개화영,간공능균정상.결론 복강경행선천성담총관낭종절제간총관공장Roux-en-Y문합술시복잡적고풍험수술,수요한숙적복강경기술화기교,술중자세、정준처리유리우감소술중、술후병발증적발생.
Objective To explore the perioperative complications in laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy for choledochal cyst in children.Methods Retrospective analyses were performed for 78 cases of laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy choledochal cyst from March 2012 to November 2013.There were 9 males and 69 females.And the types were cystic (n =61) and fusiform (n =17).Results Laparoscopic procedure was completed successfully for all cases.The average operative duration was 3.5 (2.5-5.5) hours.Intraoperative complication occurred in 3 patients.There were right hepatic duct injury (n =1),left hepatic duct separation (n =1) and bleeding of variation cholecystic artery (n =1).All three cases were treated timely during surgery without adverse consequences.Postoperative complications of 8 cases included hemorrhage (n=2),bile leakage (n =2),anastomotic stenosis (n =1),postoperative pancreatitis (n =1) and gallbladder fossa or subphrenic encapsulated fluid (n =2).Exploratory laparotomy was performed for hemorrhage (n =1) and laparoscopic hepatoenterostomy for anastomosis stricture (n =1).One case of bile leakage was cured after 3 weeks of peritoneal drainage while another case recovered completely after puncture drainage for encapsulated fluid.Postoperative pancreatitis was cured after jejunal feeding for 4 weeks.During a follow-up period of 3-22 months,reexaminations of liver function and ultrasound were made.Three cases of intrahepatic calcification were found with normal liver function.Conclusions Laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy for choledochal cyst is a complex and high-risk procedure.Precise intraoperative handling may reduce intraoperative and postoperative complications.