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目的:探讨经腹腔镜辅助行肝门解剖和肝门肠吻合术治疗先天性胆道闭锁的临床效果。方法:先天性胆道闭锁患儿12例,29~87d11例,5.5个月1例。2例为肝总管闭锁(Ⅱ型),肝门部有直径1.2~2.5cm囊肿与肝内胆管相通;10例为肝门部胆管闭锁(Ⅲ型)。于脐部纵切口置入10mmTrocar,然后分别于右上腹、右中腹和左上腹置入3个5mmTrocar。术中胆道造影,确诊为胆道闭锁,暴露肝门;切除胆囊,游离切除肝门纤维块,空肠行Roux-en-Y吻合术保留肝支30~35cm,然后将肠管送回腹腔,将空肠肝支经结肠后拉至肝门下;用5-0可吸收缝线将空肠与肝门端侧连续吻合。结果:本组12例患儿中1例因肝门渗血中转开腹手术;另11例均在腹腔镜辅助下完成手术,手术时间平均为3.5h(3.1~4.6h),出血量约10ml,没有需在术中和术后输血者,全组患儿无手术后肠粘连梗阻和腹腔感染。结论:经腹腔镜行肝门肠吻合术治疗先天性胆道闭锁安全可靠,具有暴露肝门清晰、肝门纤维块分离和切除准确、对患儿打击小等优点。
Objective: To investigate the clinical effect of laparoscopic assisted hepatic portal anatomy and hepato-enteric anastomosis in the treatment of congenital biliary atresia. Methods: 12 cases of congenital biliary atresia, 29 ~ 87d11 cases, 5.5 months in 1 case. 2 cases of hepatic duct atresia (type Ⅱ), hepatic portal has a diameter of 1.2 ~ 2.5cm cyst and intrahepatic bile duct communication; 10 cases of hilar bile duct atresia (Ⅲ). 10mmTrocar placed in the umbilicus longitudinal incision, and then were placed in the right upper quadrant, right middle and left upper quadrant 3 5mmTrocar. Intraoperative cholangiography, diagnosed as biliary atresia, exposure of the hepatic portal; removal of the gallbladder, removal of the hepatic fibrosis block free, jejunum Roux-en-Y anastomosis to retain the liver branch 30 ~ 35cm, and then the bowel back to the abdominal cavity, the jejunum liver After the branch of the colon pulled down to the liver; with 5-0 absorbable suture the jejunum and the portal end of the continuous anastomosis. Results: In the 12 cases of this group, 1 case was converted to laparotomy due to hepatic portal hemorrhage. The other 11 cases underwent laparoscopic surgery. The average operation time was 3.5h (3.1 ~ 4.6h) and the bleeding volume was about 10ml , There is no need for intraoperative and postoperative blood transfusion, the whole group of children without postoperative intestinal adhesion obstruction and abdominal infection. Conclusions: Laparoscopic anastomosis of hepatic portal intestine is safe and reliable, and it has the advantages of clear hepatic portal exposure, accurate separation and resection of hepatic fibrosis and little blow to children.