【摘要】：目的探討改進(jìn)的腹腔鏡下解剖分離技術(shù)以及膽腸吻合技術(shù)在完全腹腔鏡膽總管囊腫切除術(shù)中的應(yīng)用價值。方法 2013年10月~2016年10月,對10例成人先天性膽總管囊腫行完全腹腔鏡下膽總管囊腫切除、膽囊切除、肝管空腸Roux-en-Y吻合。腹腔鏡下超聲刀銳性分離結(jié)合吸引器沖洗鈍性解剖法游離并完整切除膽總管囊腫和膽囊,用"一點(diǎn)法"全程全層連續(xù)縫合技術(shù)行肝管空腸端側(cè)吻合,用腔鏡下直線切割吻合器行空腸側(cè)側(cè)吻合。結(jié)果全組均成功完成腹腔鏡手術(shù),無中轉(zhuǎn)開腹。手術(shù)時間150~310 min,平均184.3 min,其中"一點(diǎn)法"肝管空腸吻合時間18~45 min,平均22.7 min。術(shù)中出血量30~120 ml,平均50.5 ml。術(shù)后第1天疼痛評分1~4分,平均2.0分,肛門排氣時間1~3 d,平均2.0 d,術(shù)后住院時間5~11 d,平均6.0 d。1例術(shù)后少量膽漏,余無圍手術(shù)期并發(fā)癥。10例均獲得隨訪,隨訪時間2~36個月,平均17.2月,1例術(shù)后21天因飲食因素導(dǎo)致空腸吻合口炎,保守治愈,無反流性膽管炎、吻合口狹窄等。結(jié)論完全腹腔鏡下應(yīng)用超聲刀銳性分離結(jié)合吸引器沖洗鈍性解剖法切除成人先天性膽總管囊腫是安全、有效的。"一點(diǎn)法"全程全層連續(xù)膽腸吻合技術(shù)能夠簡化操作及降低腹腔鏡下縫合難度,有助于腔鏡術(shù)式的開展。
[Abstract]:Objective to evaluate the value of improved laparoscopic dissection technique and choledochojejunostomy in laparoscopic choledochal cyst resection. Methods from October 2013 to October 2016, 10 adult patients with congenital choledochal cyst underwent laparoscopic choledochal cyst resection, cholecystectomy and Roux-en-Y anastomosis of hepatojejunum. The choledochal cyst and gallbladder were dissected and completely resected by laparoscopic ultrasonic scalpel sharp separation combined with suction flushing. The end-to-side anastomosis of hepatic duct jejunum was performed by "one point" technique of whole layer continuous suture. Lateral jejunal anastomosis was performed by endoscopic straight cutting stapler. Results Laparoscopic surgery was performed successfully in all patients. The average operative time was 184.3 min, (150 ~ 310 min,), and the mean time of jejunostomy of "one point method" was 1845 min, (22.7 min.). Intraoperative bleeding volume of 30 ~ 120 ml, averaged 50.5 ml. On the first day after operation, the pain score was 1 ~ 4 (mean 2.0), the anus exhaust time was 1 ~ 3 days (average 2.0 days), the postoperative hospitalization time was 511 days, the average time was 6.0 days in 1 case with a small amount of bile leakage, the remaining 10 cases were followed up without perioperative complications. The follow-up time was 2 ~ 36 months. An average of 17.2 months was found in 1 case with jejunal anastomosis caused by dietary factors at 21 days after operation, which was conservatively cured without reflux cholangitis and anastomotic stricture. Conclusion it is safe and effective to dissect congenital choledochal cyst in adults by means of sharp separation with ultrasonic scalpel combined with blunt dissection of aspirator under complete laparoscopy. " One point method can simplify the operation and reduce the difficulty of laparoscopic suture, which is helpful for the development of endoscopic operation.
【作者單位】： 上海市浦東醫(yī)院復(fù)旦大學(xué)附屬浦東醫(yī)院肝膽外科;
【基金】：上海市浦東新區(qū)衛(wèi)生系統(tǒng)學(xué)科帶頭人培養(yǎng)計(jì)劃(編號:PWRd2016-04) 浙江省自然科學(xué)基金項(xiàng)目(編號:LY16H160045) 杭州市科技發(fā)展計(jì)劃項(xiàng)目(編號:20150733Q16)
【分類號】：R657.4

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本文編號：2208406