摘要
目的探讨杂交腹腔镜策略下Roux-en-Y胆肠吻合术的可行性和安全性。方法回顾性分析2017年1月至2020年7月在山东省日照市肝胆胰脾外科研究所、山东省滨州市第二人民医院肝胆外科、北京朝阳医院西院肝胆胰脾外科实施杂交腹腔镜策略下Roux-en-Y胆肠吻合术的30例患者的病例资料。结果30例患者中胆总管结石合并Oddi括约肌狭窄15例(50.0%),胆总管扩张合并十二指乳头憩室5例(16.7%),胆管结石伴反流性胆管炎4例(13.3%),胆总管囊肿4例(13.3%),胆管中段癌2例(6.7%);主要临床表现包括恶心伴呕吐15例(50.0%),腹痛24例(80.0%),黄疸伴发热16例(53.3%)。建立气腹后于腹腔镜下处理胆道病变,开腹制作Roux-en-Y,腹腔镜下完成胆肠吻合术,27例(90.0%)脐部延长切口长度为4~6cm,3例(10.0%)因肥胖将脐部切口延长至8cm;远端游离襻为55~60cm;手术时间为185~265min;术中出血量为30~300ml。术后4例发生一过性胆瘘,每日引流量小于50ml,3~7d内愈合;无切口感染及切口疝发生;住院时间13~23d,平均16.7d。术后随访2~44个月,均未发生反流性胆管炎、胆管结石复发、吻合口狭窄等并发症。结论杂交腹腔镜策略下Roux-en-Y胆肠吻合术疗效可靠,安全性好,技术要求简单,费用较低,适用于基层医院及腹腔镜技术尚在学习曲线内的医师。
Objective To investigate the feasibility and safety of Roux-en-Y choledochojejunostomy under hybrid laparoscopic strategy.Method From January 2017 to July 2020,30 patients with Roux-en-Y choledochojejunostomy under hybrid laparoscopic strategy were enrolled in the retrospective study to investigate the clinical data.Result Among the 30 cases,13 patients were males and 17 patients were females;the age rangs was 32 to 80 years old,and the median age was 63 years old;15 cases(50.0%)of choledocholithiasis with Oddi sphincter stenosis,5 cases(16.7%)of choledocholithiasis with duodenal diverticulum,4 cases(13.3%)of choledocholithiasis with reflux cholangitis,4 cases(13.3%)of choledocholithiasis,and 2 cases(6.7%)of carcinoma of the middle bile duct.Main clinical manifestations:nausea with vomiting in 15 cases(50.0%),abdominal pain in 24 cases(80.0%),jaundice with fever in 16 cases(53.3%).The length of the extended umbilical incision in 27 cases(90.0%)was 4-6cm,3 cases(10.0%)had umbilical extensions up to 8cm due to obesity;the length of the bile duct loop was 55-60cm;intraoperative blood loss was 30-300ml.Transient postoperative bile leakage occurred in 4 cases,the amount of drainage was less than 50ml/day,and the wound healed within 3 to 7 days,without incision infection or incisional hernia.The hospitalization time was 13-23days,with an average of 16.7 days,the follow-up time was 2-44 months,and there were no long-term complications such as reflux cholangitis,recurrence of bile duct stones and anastomotic stenosis.Conclusion Roux-en-Y choledochojejunostomy under hybrid laparoscopic strategy has reliable efficacy,safety,simple technical requirements and low cost.It is suitable for primary hospitals and physicians whose laparoscopic technology is still within the learning curve.
作者
徐衍杰
孔新亮
王强
桑遥彩
李尚胜
丁建华
王向涛
孙文兵
Xu Yanjie;Kong Xinliang;Wang Qiang;Sang Yaocai;Li Shangsheng;Ding Jianhua;Wang Xiangtao;SUN Wenbing(Shandong Rizhao Institute of Hepatobiliary-Pancreatic-Splenic Surgery,Shandong Rizhao 276800,China;Department of Hepatobiliary Surgery,Shandong Binzhou Second People’s Hospital,Shandong Binzhou 256800,China;Department of Hepatobiliary-Pancreatic-Splenic Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)
出处
《中国医刊》
CAS
2021年第3期268-270,共3页
Chinese Journal of Medicine
