腹腔镜下胆总管囊肿手术开腹指征及并发症预防的探讨.pdfVIP

够和碧隧 UNIONHOJP!，_：4l 舜_撕一丽一震 腹腔镜下胆总管囊肿手术开腹指征及并发症预防的探讨 席红卫崔强强王建峰张鹏崔娆靳园园 山西省儿童医院 摘要目的：探讨腹腔镜下胆总管囊肿切除、肝总管空肠吻合术中转开腹指征及手术中和手术后并发症的 预防。方法：腹腔镜下行胆囊造影，了解胆总管扩张情况，了解是否存在肝内胆管及胰腺管畸形。同时行 胆总管囊肿切除、肝总管空肠Roux．Y吻合术。结果：8例胆总管囊肿术前均行B超及CT等影像学检查。 7例均在腹腔镜辅助下完成，其中1例因囊肿壁炎症重，故中转开腹。术后1例因患儿烦躁、活动过度， 引流管戳伤吻合口造成吻合口漏，开腹再次吻合。l例术后形成胰腺囊肿，继续引流，1个月后囊肿自行 消失。手术时间3。5．6．5小时。病人年龄4个月．12岁。结论：腹腔镜下胆总管囊肿切除、肝总管空肠吻合 手术效果可靠，对患儿打击小，术后恢复快。但在囊肿感染严重、手术时间长、发现有肝内胆管或胰腺管 畸形时应及时开腹。熟练的手术技巧、术中谨慎操作及术后仔细护理是减少并发症的关键。 关键词：胆总管囊肿，腹腔镜，开腹术，并发症 of andPreventionof in ExplorationTumingLaparotomy ComplicationLaparoscopic with Roux-Y forCholedochal Cyst-excisionHepatoenterostomyCyst Xi a1． hong-wci，Cuiqiang-qiang，Wangjian—feng，Ct ofPediatric Children’s Department Surgery，ShanxiHospital，Taiyuan，Shanxi，030013 Abstract the in indicatorof and of Objective：Toexplore complication turninglaparotomyprevention excisionofcholedochalandRoux-Y forthetreatmentofcholedochal laparoscopic cyst hepatoenterostomy cyst inchildren．Methods：Underthe of was tounderstandthe guidance laparoscope，cholecystographyoperated conditionofcholedochus，andof ductand expansion abnormalityintrahepaticpancreatic excisionofcholedochalandRoux—Y werecarriedout．Results：8casesofeholedochal cyst hepatoenterostomy wereexaminedwithB-ultrasoundandCTbefore werecarriedout excisionof cyst operation．7cases Laparoscopic to becausedof inflammation choledochalandRoux-Y caseturned cyst hepatoenterostomy．1laparotomy heavy case drain of wallandmuch anastomoticafter the stabcd cyst bleeding．1appeared leakageoperation，because casewas outwith and anastomoticstomawiththechild’S andmuch carried dysphoria unsteady．The laparotomy anastomosis．1case after after drained1 month．The appearedpancreaticcyst operation，disappearedbeing to timeswere3．5—6．5hours．The were from4months12 Conclusion： operation patientsaged years． of and forthetreatment excisioncholedochalRoux-Y ofcholedochal Laparoscopic cyst hcpatocntcrostomy cyst was andsafe inchildren．Butthe mustbecarriedoutin in