摘要
目的探讨微小切口肝门空肠Roux-en-Y吻合术的可行性和疗效。方法 2008年3月～2010年6月腹腔镜下胆道造影或探查术确诊Ⅲ型胆道闭锁82例,行微小切口肝门空肠Roux-en-Y吻合术。上腹横切口,4把S拉钩分别在上下左右对拉,暴露肝门,游离切除胆囊,彻底游离切除肝门纤维块,行肝门空肠吻合。结果 82例均完成微小切口肝门空肠Roux-en-Y吻合手术。手术切口长度平均4.2 cm(4～4.5 cm);开腹手术操作时间平均71.8 min(55～90 min);平均出血量8.3 ml(5～20 ml),无术中输血者。均未放置腹腔引流。术后24～48 h拔除胃管,48～72 h进食。无围手术期死亡病例。术后第2天消化道出血1例,术后切口裂开2例。82例随访6～18个月,平均10.5月,术后4周获得胆汁引流率(直接胆红素降至正常水平或较术前下降超过60%)占69.5%(57/82),术后胆管炎发作3次以上占29.3%(24/82)。结论微小切口肝门空肠Roux-en-Y吻合术治疗胆道闭锁,可以不将肝脏拖出腹腔外进行吻合,避免对患儿循环系统的严重影响,同时直视下肝门空肠吻合可以保证吻合确切在门静脉后方,手术安全可靠。
Objective To investigate the feasibility and efficacy of hepaticojejunostomy with micro incision for type Ⅲ biliary atresia.Methods A total of 82 patients with type Ⅲ biliary atresia underwent hepaticojejunostomy（Roux-en-Y anastomosis） with micro incision in our hospital from March 2008 to June 2010.With a transverse incision at the upper abdomen,we exposed the hepatic porta with four S-shape retractors,so that to remove the gall bladder,separate the fibrositic tissues and then perform hepaticojejunostomy.Results All the patients were treated successfully with the Roux-en-Y anastomosis with a mean 4.2-cm incision（4-4.5）,and operation time 71.8 min（55-90）.The intraoperative blood loss was 8.3 ml in average（5-20）,no patient received blood transfusions,nor intraperitoneal drainage.Gastric tube was withdrawn in 24 to 48 hours postoperation,and the patients resumed diet in 48-72 hours.One patient developed gastrointestinal bleeding at day 2 postoperation,and two patients had the incision disrupted after the surgery.No patient died during and after the operation.Follow-up was achieved in 82 cases for 6 to 18 months with a mean of 10.5 months.69.5%（57/82） of the patients showed bile flow in four weeks postoperation（direct bilirubin decreased to a normal range or reduced by 60%compared to pre-operation）.Postoperative cholangitis occurred for over three times in 29.3%（24/82） of the patients.Conclusions Mini-incision hepaticojejunostomy for biliary atresia is safe and effective.With the procedure,it is not necessary to perform anastomosis outside the abdominal cavity,and thus the influence on the circulation system can be avoided;at the mean time we can make sure the anastomotic site is behind the portal vein.
出处
《中国微创外科杂志》
CSCD
2011年第8期683-684,693,共3页
Chinese Journal of Minimally Invasive Surgery
基金
首都临床特色应用研究(D101100050010064)
