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目的探讨腹腔镜辅助肝管空肠Roux-en-Y吻合术治疗3岁以内婴幼儿先天性胆总管囊肿的疗效。方法2001年4月～2007年3月,采用腹腔镜技术治疗3岁以内婴幼儿先天性胆总管囊肿52例,其中囊状扩张44例,梭形扩张8例。12例(23%)患儿合并肝门部肝管狭窄,行肝管扩大成形术;采用四孔技术和3～5 mm手术器械完成胆道造影、胆囊和胆总管囊肿壁全层彻底切除;延长脐部切口提出空肠,直视下行Roux—en—Y空肠吻合,然后还纳肠管;经结肠后上提空肠的肝支,镜下将肝管与空肠连续吻合。结果52例在腹腔镜下完成手术,无中转开放手术,平均手术时间226 min(160～455 min),手术中出血量5～10 ml,无手术中需要输血者。1例肝门胆管狭窄的患儿术后胆漏,持续腹腔引流26 d,自然愈合。术后1～2 d进食,无并发症患儿住院3～6 d。52例术后随访3～72个月,平均32.6月,肝功能正常,无并发胆管狭窄和胆管炎,无结石和胰腺炎发生。结论腹腔镜胆总管囊肿彻底切除肝管空肠Roux—en—Y吻合手术治疗3岁以内婴幼儿先天性胆总管囊肿安全、可靠,镜下放大的手术视野有利于精确的手术操作。
Objective To investigate the efficacy of laparoscopic assisted Roux-en-Y hepaticojejunostomy in the treatment of congenital choledochal cyst in infants under 3 years of age. Methods From April 2001 to March 2007, 52 cases of congenital choledochal cyst were treated by laparoscopy in infants under 3 years of age, including 44 cases of cystic dilatation and 8 cases of fusiform expansion. Thirteen children (23%) with hepatic duct stricture of hepatic hilar were undergone hepatic duct enlargement and angioplasty. Four-hole technique and 3 to 5 mm surgical instruments were used to complete cholangiogram. The gallbladder and common bile duct wall were completely excised in full thickness. Umbilical incision proposed jejunum, Roux-en-Y jejunal anastomosis straight down, and then also accept the intestine; colon after the lift of the jejunum liver, microscopic hematoma and jejunum continuous anastomosis. Results 52 cases underwent laparoscopic surgery without any intervention. The average operation time was 226 min (160 ~ 455 min) and the amount of bleeding during operation was 5 ~ 10 ml. No transfusions were needed during the operation. One case of hilar cholangiocarcinoma had bile leakage after operation, sustained abdominal drainage for 26 days and healed naturally. 1 ~ 2 d after eating, no complications in children hospitalized 3 ~ 6 d. 52 cases were followed up for 3 to 72 months with an average of 32.6 months, with normal liver function, no complicated biliary stricture and cholangitis, and no stones and pancreatitis. Conclusions Laparoscopic choledochal cyst radical resection of Roux-en-Y hepaticojejunostomy is safe and reliable for the treatment of congenital choledochal cysts in infants and children younger than 3 years. The magnifying scope of the surgical field is conducive to accurate operation.