完全腹腔镜成人胆总管囊肿切除术的技术改进

发布时间：2018-08-27 20:47

【摘要】：目的探讨改进的腹腔镜下解剖分离技术以及胆肠吻合技术在完全腹腔镜胆总管囊肿切除术中的应用价值。方法 2013年10月~2016年10月,对10例成人先天性胆总管囊肿行完全腹腔镜下胆总管囊肿切除、胆囊切除、肝管空肠Roux-en-Y吻合。腹腔镜下超声刀锐性分离结合吸引器冲洗钝性解剖法游离并完整切除胆总管囊肿和胆囊,用"一点法"全程全层连续缝合技术行肝管空肠端侧吻合,用腔镜下直线切割吻合器行空肠侧侧吻合。结果全组均成功完成腹腔镜手术,无中转开腹。手术时间150~310 min,平均184.3 min,其中"一点法"肝管空肠吻合时间18~45 min,平均22.7 min。术中出血量30~120 ml,平均50.5 ml。术后第1天疼痛评分1~4分,平均2.0分,肛门排气时间1~3 d,平均2.0 d,术后住院时间5~11 d,平均6.0 d。1例术后少量胆漏,余无围手术期并发症。10例均获得随访,随访时间2~36个月,平均17.2月,1例术后21天因饮食因素导致空肠吻合口炎,保守治愈,无反流性胆管炎、吻合口狭窄等。结论完全腹腔镜下应用超声刀锐性分离结合吸引器冲洗钝性解剖法切除成人先天性胆总管囊肿是安全、有效的。"一点法"全程全层连续胆肠吻合技术能够简化操作及降低腹腔镜下缝合难度,有助于腔镜术式的开展。
[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.
【作者单位】：上海市浦东医院复旦大学附属浦东医院肝胆外科;
【基金】：上海市浦东新区卫生系统学科带头人培养计划(编号:PWRd2016-04) 浙江省自然科学基金项目(编号:LY16H160045) 杭州市科技发展计划项目(编号:20150733Q16)
【分类号】：R657.4

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