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目的探讨腹腔镜胆总管囊肿切除肝管空肠Roux-en-Y吻合术后并发症和预防。方法2001年7月～2006年6月,经腹腔镜行先天性胆总管囊肿根治术66例(65例为2个月～14岁,中位数3岁9个月,另1例28岁)。囊肿型61例,直径2.5～18cm;梭形5例,直径1.2～2.2cm。其中9例合并肝门部肝管狭窄,行肝管扩大成形术。结果66例均在腹腔镜下成功完成手术,平均手术时间3.8h(2.6～9.5h),术后平均住院时间4.5d(3～8d)。早期并发症:胆漏2例,1例腹腔引流后自愈,另1例因腹腔引流不畅行开腹手术,术中见吻合口漏,重新吻合后愈合;1例术后7h高血钾(10.8mmol/L)心跳停止,复苏成功后于术后第3天死于肾功能衰竭;应激性溃疡2例,自行缓解。无腹腔和伤口感染。远期并发症:术后6个月突发肠梗阻1例,开腹探查见空肠肝支肠管粘连梗阻坏死,行肠切除吻合手术。无吻合口狭窄和胆管炎,65例存活者随访6～56个月,中位数21个月,行B超检查未见胆石发生,肝功能正常。结论经腹腔镜行先天性胆总管囊肿切除肝管空肠Roux-en-Y吻合术是复杂的高风险手术,有与开腹手术类似的胆漏、应激性溃疡和肠梗阻并发症。高钾血症是该手术特殊的严重并发症,可能与长时间的CO2气腹有关,术后必须常规监测血钾变化。
Objective To investigate the complications and prevention of Roux-en-Y anastomosis after laparoscopic choledocholithotomy. Methods From July 2001 to June 2006, 66 patients underwent laparoscopic radical choledochal cyst radical surgery (65 patients were 2 months to 14 years old, with a median of 3 years and 9 months and another 28 years old). Cyst type 61 cases, diameter 2.5 ~ 18cm; fusiform in 5 cases, diameter 1.2 ~ 2.2cm. 9 cases of hepatic hilar stenosis, hepatic duct enlargement angioplasty. Results All 66 patients underwent laparoscopic surgery. The average operation time was 3.8h (2.6-9.5h) and the average postoperative hospital stay was 4.5d (3-8d). Early complications: 2 cases of bile leakage, 1 case of self-healing after peritoneal drainage, the other case of laparotomy due to abdominal laparotomy, anastomotic leakage, re-anastomosis and healing; 1 case of hyperkalemia 10.8mmol / L) cardiac arrest, after the success of the resuscitation on the 3rd postoperative death from renal failure; stress ulcer in 2 cases, relieve themselves. No abdominal and wound infections. Long-term complications: 6 cases of sudden intestinal obstruction in 1 case, open exploration to see the jejunum liver and intestinal adhesions obstruction necrosis, bowel resection and anastomosis. No anastomotic stricture and cholangitis, 65 cases of survival were followed up for 6 to 56 months, the median 21 months, line b-ultrasound did not find occurrence of gallstone, liver function is normal. Conclusions Laparoscopic Roux-en-Y anastomosis of the hepatic duct and jejunum is a complicated and high-risk surgery. There are biliary leaks, stress ulcer and intestinal obstruction which are similar to laparotomy. Hyperkalemia is a special and serious complication of this procedure, which may be related to prolonged CO 2 pneumoperitoneum. Postoperative changes in serum potassium must be routinely monitored.