摘要
目的报道新疆医科大学第一附属医院近两年行腹腔镜Roux-en-Y胆管空肠吻合术的病例特点及手术方式,探讨完全腹腔镜Roux-en-Y胆管空肠吻合术在开展及应用过程中的技巧与方法。方法患者9例,其中男性5例,女性4例,平均年龄64岁,术前行增强CT及MRI,诊断为胆总管结石(3例)、胆总管囊肿(1例)、胰头癌(2例)、壶腹癌(1例)、胆总管狭窄(1例)、医源性胆道损伤(1例),所有患者均无绝对手术禁忌,均行腹腔镜Roux-en-Y胆管空肠吻合术,恶性肿瘤患者均在术前与患者及其家属沟通后要求行姑息手术。手术过程基本可分为处理原发病(姑息手术除外)、胆囊切除、分离修整胆总管、消化道重建、胆肠吻合。结果所有病例均顺利完成手术,平均手术时间360 min,术中出血量130 ml,术后住院时间9 d;术后1例胆总管结石患者并发胆漏及胸腔积液经腹腔引流10 d后治愈,另1例粘连性胆道狭窄患者并发胸腔积液于出院前好转。结论采用腹腔镜胆管空肠Roux-en-Y吻合术进行胆道重建具有充分的可行性,虽然存在手术难度大、对手术团队的操作及配合要求高等问题,但仍然是目前胆肠吻合术的首选术式。
Objective To report the characteristics and surgical procedures of laparoscopic Roux-en-Y choledochojejunostomy(LRCJ),investigate skills and methods in development and application of LRCJ.Methods Nine patients underwent LRCJ.Indication included choledochlithiasis in one patient,latrogenic biliary tract injury one patient,benign stricture on 3 patients,pancreatic cancer in 2 patients,choledochalcyst in one patient,ampullary carcinoma in one patient.All malignant tumors are unresectable in4 patients.The patients with cancer and their families agree with palliative operation.All surgeries were performed by 5 stages included treatment of primary disease,cholecystectomy,separation and transection common bile duct,alimentary reconstruction and choledochojejunostomy.ResultsAll of the operations were performed successfully.The mean operative time was 360 minutes.The mean blood loss was 130 ml,and the meanpostoperative hospital stay was 9 days.One case had complicated with bile leak,healed by drainage before discharge for 10 days.The other had complicated with hydrothorax relieved after conservative medical therapy.ConclusionsLRCJ is feasible and safe for biliary disease.Although there are some technical difficulties for this procedure,LRCJ should be the first choice for most of biliary reconstruction.
出处
《中华腔镜外科杂志（电子版）》
2017年第3期150-154,共5页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
