摘要
目的:总结为肝总管直径≤5 mm的胆总管囊肿患儿行腹腔镜囊肿切除+肝总管空肠Roux-en-Y吻合术中胆肠吻合的临床经验。方法:回顾分析2018年1月至2019年4月腹腔镜胆总管囊肿根治术中发现的6例肝总管直径≤5 mm的顿挫型胆总管囊肿患儿的临床资料,其中男1例,女5例。患儿9个月~4岁,平均(25.5±14.7)个月。术前转氨酶升高5例,胆红素升高2例,囊肿感染2例,合并胰腺炎1例。肝总管与肠管后壁用5-0可吸收缝线连续缝合,前壁间断缝合,缝合完毕后依次打结。统计手术前后转氨酶、胆红素、淀粉酶等指标,观察术中胆肠吻合时间、术后胆漏、吻合口狭窄、胆管结石及肝管扩张情况。结果:6例患儿中2例肝总管直径4 mm,4例5 mm,均成功完成肝总管空肠吻合,胆肠吻合时间20~30 min,术后无胆漏发生,随访17~34个月,平均(22.7±6.2)个月,患儿转氨酶、胆红素、淀粉酶均恢复正常。术后随访,B超检查示无吻合口狭窄、胆管结石及肝管扩张发生。结论:肝总管直径≤5 mm的顿挫型胆总管囊肿行腹腔镜根治手术时,采用可吸收缝线连续缝合肝总管后壁与空肠、间断缝合前壁,然后依次打结是安全、可行的。
Objective:To summarize the experience of hepaticojejunostomy in laparoscopic choledochal cyst resection and Roux-en-Y hepaticojejunostomy with the diameter of the common hepatic duct≤5 mm.Methods:From Jan.2018 to Apr.2019,clinical data of 6 children(1 male and 5 females),who suffered from forme fruste choledochal cyst with the diameter of the hepatic duct≤5 mm and underwent laparoscopic radical resection,were retrospectively analyzed.The age of patients ranged from 9 months to 4 years with the average of(25.5±14.7)months.There were 5 cases of elevated transaminase,2 cases of elevated bilirubin,2 cases of cyst infection and 1 case of pancreatitis before operation.The common hepatic duct was continuously sutured with 5-0 absorbable suture on the back wall of the intestine,and the front wall was sutured intermittently.After suturing,each suture was tied sequentially.The transaminase,bilirubin,amylase and other indexes before and after operation,as well as hepaticojejunostomy time were counted.Biliary leakage,anastomotic stenosis,bile duct stones and hepatic duct dilatation were followed up after operation.Results:The diameter of hepatic duct was 4 mm in 2 cases and 5 mm in 4 cases.All 6 cases of hepaticojejunostomy were successfully completed.The operative time of hepaticojejunostomy was 20-30 min.No bile duct leakage was found after the operation.The postoperative follow-up was 17-34 months,with an average of(22.7±6.2)months.All patients returned to normal in terms of transaminase,bilirubin and amylase.Postoperative B-ultrasound follow-up showed no anastomotic stricture,bile duct stones or dilatation of the hepatic duct.Conclusions:When the diameter of the common hepatic duct of forme fruste choledochal cyst is no more than 5 mm,the posterior wall of the common hepatic duct can be sutured with jejunum continuously under laparoscopy,and the anterior wall can be sutured with intermittent suture,then each suture is sequentially tied,this method is safe and feasible.
作者
陈立才
刘江斌
徐伟珏
盛庆丰
吕志宝
CHEN Li-cai;LIU Jiang-bin;XU Wei-jue(Department of General Surgery,Shanghai Children’s Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)
出处
《腹腔镜外科杂志》
2021年第8期630-634,共5页
Journal of Laparoscopic Surgery
关键词
胆总管囊肿
腹腔镜检查
胆肠吻合
儿童
Choledochal cyst
Laparoscopy
Choledochojejunostomy
Child
作者简介
陈立才(1987—)男,上海市儿童医院普通外科主治医师,主要从事小儿外科学方面的研究;通讯作者:刘江斌,E-mail:ljbin888@163.com。
