腹腔镜行巨大先天性胆总管囊肿切除术的探讨

目的 对腹腔镜下行巨大先大性胆总管囊肿切除肝管空肠Roux—Y吻合术进行探讨。方法对7例巨大胆总管囊肿(直径11～21cm)行囊肿切除 肝管空肠Roux—Y吻合术。术中行囊肿穿刺减压，切除胆囊，然后从扩张囊肿的中部横断囊肿前壁吸出胆汁，将囊肿壁全层分7～8块逐渐彻底切除。结果7例患儿均顺利完成巨大胆总管囊肿切除 肝管空肠Roux—Y吻合术，无中转开腹手术者。手术时间5．5h～7．6h，平均6．3h；出血最5ml～15ml；6例患儿切除远端囊肿时未找到与胰管相通的管道，仅l例见到明确的远端狭窄的肝管予以结扎。术后无切口感染、胆漏、胰漏和肠梗阻发生，均3d拔除腹腔引流管。术后住院时间4d～6d。随访3个月～19个月，无胆管炎和结石发生，肝功能检查指标均在正常范围内。结论腹腔镜下巨大先天性胆总管囊肿切除、肝管空肠Roux—Y吻合术是一种安全可靠的手术方法。     

腹腔镜胆总管囊肿切除肝管空肠Roux-Y吻合术

先天性胆总管囊肿是小儿常见的胆道畸形,囊肿彻底切除肝管空肠Roux-en-Y吻合术已成为目前治疗先天性胆总管囊肿的标准术式。经腹腔镜先天性胆总管囊肿切除肝管空肠Roux-en-Y吻合术     

经腹腔镜行先天性胆总管囊肿切除肝管空肠Roux-Y吻合术的探讨

目的 探讨经腹腔镜行先天性胆总管囊肿切除，肝管空肠Roux-Y吻合术的可行性。方法 先天性胆总管囊肿5例，在腹腔镜监视下行胆囊穿刺胆道造影术，显示肝胆管和胰管病变，用电切或电凝切除胆总管囊肿。经脐部切口提出空肠，于腹壁外行空肠Roux-Y吻合，用5-0可吸收缝线，在腹腔镜监视下，将肝管与空肠端侧吻合。结果 本组5例患儿手术全部成功，手术时问平均为5．1h，(4．5h～6h)出血量20m1～50ml，吻合口直径1．0cm～1．5cm，平均住院时间6．5d，术后随访1个月～4个月，无肠粘连梗阻和吻合口狭窄发生。患儿肝功能各项指标正常。结论 经腹腔镜行先天性胆总管囊肿切除，肝管空肠吻合术是一种安全可靠的方法，具有创伤小，视野清楚，分离缝合准确、术后恢复快等优点。     

改良囊肿切除肝管空肠Roux-Y吻合术治疗先天性胆总管囊肿

目的：探讨治疗小儿先天性胆总管囊肿的手术方法。方法：本组30例,男12例,女18例,年龄14月至6岁,均采用改良囊肿切除、肝管空肠Roux-Y吻合术治疗。结果：30例均痊愈出院。随访3个月至5年,未出现腹痛、黄疸、发热等症状。经B超检查,未见胆管狭窄;6例消化道钡餐检查未见钡剂返流入肝管空肠吻合口。结论：改良囊肿切除、肝管空肠Roux-Y吻合术是治疗先天性胆总管囊肿的较好方法。     

先天性胆总管囊肿合并门脉高压症

目的 探讨先天性胆总管囊肿（ＣＣ）合并门脉高压的原因、类型及转归。方法 将１７例ＣＣ合并门脉高压与１３例ＣＣ不合并门脉高压者进行比较,项目包括病程、胆源性发热、胆总管囊肿的最大前后径、胆道压力、肝组织病理变化、病理图像分析,对门脉高压患儿进行随访。结果 门脉高压组（ＰＨ）胆源性发热发生率高,胆道压力高于非门脉高压组（ＮＰＨ）,门脉高压组肝组织病理观察发现：１４例肝小叶完整,门静脉及肝静脉分支走行正     

经腹腔镜治疗新生儿先天性胆总管囊肿

目的 对经腹腔镜行囊肿彻底切除,肝管空肠Roux-en-Y吻合术治疗新生儿胆总管囊肿的可行性、安全性进行探讨.方法 自2003年4月至2007年4月本院收治罹患先天性胆总管囊肿新生儿9例,其中男2例,女7例;年龄13～28d(平均24d).9例转氨酶都升高,均为囊肿型,囊肿直径2.5～8cm(平均3.8cm),其中8例患儿合并黄疸,4例出现陶土样便.采用经腹腔镜行囊肿彻底切除,肝管空肠Roux-en-Y吻合术,监测术前和术后黄疸指标变化.结果 9例患儿均成功手术,手术时间为3.3～4.0h(平均3.6h),出血量约5～10ml;无中转开腹,无术中并发症发生.术后14～28h(平均18h)排气,1～3d(平均1.5d)排便,留置胃管14～30h(平均19h),术后进食时间16～30h(平均20h),腹腔引流放置时间57h(46～72h),术后3～9d(平均5d)黄疸消退,术后7d转氨酶及直接胆红素不同程度下降.术后住院时间4～9d(平均6.3d).随访3～45个月,肝功能正常,无胆管炎、吻合口狭窄、肠粘连梗阻等并发症.结论 由有丰富腹腔镜胆总管囊肿切除经验的医师实施手术,经腹腔镜行囊肿彻底切除,肝管空肠吻合术治疗新生儿先天性胆总管囊肿是一种安全、可靠的方法.     

先天性胆总管囊肿手术治疗的探讨

先天性胆总管囊肿目前公认的首选术式是囊肿切除、肝管空肠Ｒｏｕｘ－Ｙ吻合术,但有少数患儿术后经常发生腹痛、胆管炎等并发症。１９８０年１月～１９９７年７月,我们行胆总管囊肿切除术３０例,其中囊肿切除后行肝管切开肝肠高位大口吻合术１０例,由于注重解除了肝门...     

腹腔镜下手术治疗先天性胆总管囊肿198例分析

目的探讨腹腔镜下手术治疗先天性胆总管囊肿的中短期效果,总结临床体会。方法回顾性分析2006年10月至2014年4月我们收治的198例腹腔镜下胆总管囊肿患儿临床资料。其中男性53例,女性144例;年龄1个月至13岁,平均年龄38.2个月。临床特征:102例为间歇性右上腹痛,25例黄疸,7例排陶土便,13例存在腹部包块,45例有肝功能损害,31例血淀粉酶升高。均予囊肿切除、肝管-空肠Roux-en-Y吻合术。总结分析术中、术后及随访情况。结果 198例患儿囊肿直径1~20 cm,平均4.26 cm,其中囊状扩张186例,梭型扩张12例。Todari's分型Ⅰ型191例,Ⅳ型7例。198例中,19例中转开腹手术,其中9例炎症粘连剧烈,4例肝总管细小,2例囊肿突入十二指肠,2例囊肿巨大术野暴露不清楚,1例腹腔镜下无法确认肝管,1例见右副肝管。其余179例顺利完成腹腔镜下胆总管囊肿切除、肝管-空肠Roux-en-Y吻合胆道重建术。手术时间130~480 min,平均255 min。术后6例出现胆漏,3例出现吻合口狭窄,其中5例再次行开腹手术。1例出现输入袢粘连绞窄坏死,重新行Roux-en-Y吻合。1例出现粘连性肠梗阻,经保守治疗好转。其余病例随访3个月至8年,无并发症,肝功能均正常。结论腹腔镜下手术治疗先天性胆总管囊肿具有切口小、暴露清晰、恢复快等优点,但对术者要求较高,术中操作困难时及时中转开腹手术,可降低手术风险,减少并发症的发生。     

达芬奇机器人辅助腹腔镜胆总管囊肿根治术治疗儿童胆总管囊肿

目的总结达芬奇机器人辅助腹腔镜胆总管囊肿根治术治疗胆总管囊肿患儿的临床经验。方法回顾性分析中山大学附属第一医院小儿外科自2015年12月至2020年1月运用达芬奇机器人辅助腹腔镜胆总管囊肿根治术治疗的15例胆总管囊肿患儿。其中,男3例,女12例;患儿年龄为(62.40±34.64)个月,体重为(19.67±11.84)kg;Ⅰ型10例,Ⅳa型5例。患儿就诊的主要症状是腹痛和呕吐,术前行B型超声、CT或者磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)检查,发现胰胆管合流异常7例,诊断明确后采用达芬奇机器人辅助手术治疗。结果1例因肝右动脉解剖变异中转开放手术,其余14例均顺利完成达芬奇机器人辅助腹腔镜胆总管囊肿根治术,手术时间为(341.40±65.54)min,范围为240~460 min;机器人操作时间为(170.71±41.97)min,范围为95~243 min;胆肠吻合时间为(40.18±15.39)min,范围为25~67 min;胆肠吻合口直径为(14.57±9.94)mm,范围为4~35 mm。2例患儿术中输血;2例术中发现右副肝管,予行达芬奇机器人辅助下肝总管副肝管侧侧吻合术后再行肝管空肠吻合术。所有患儿随访至今,无近期或远期并发症出现。结论达芬奇机器人辅助腹腔镜胆总管囊肿根治术可顺利完成对直径较细肝总管和合并副肝管患儿的胆肠吻合,是一种安全有效的方法。     

儿童胆总管囊肿合并肝外副肝管畸形1例

肝外副肝管是指除左、右肝管外，其他从某肝叶独立发出的，并在肝十二指肠韧带内与肝外胆道的不同部位汇合的肝管，它的出现增加了肝胆手术的难度和风险。国内外对胆总管囊肿伴副肝管的发现和处理报道不多，本院近期收治1例儿童先天性胆总管囊肿并肝外副肝管畸形病例。     

Accessory hepatic duct associated with a choledochal cyst

This case report describes an accessory hepatic duct (AHD) identified by intraoperative cholangiography during excisional surgery of a choledochal cyst (CC). The accessory duct was divided and reconstructed successfully to the Roux-en-Y jejunal loop. The postoperative course was uneventful, and follow-up abdominal sonography revealed neither evidence of biliary tract obstruction nor atrophic changes of the liver. It is advocated that an AHD should be meticulously reconstructed if it is divided during excisional surgery of a CC.     

Children presenting with hydatid cysts in common bile duct and choledochal cyst

Hydatid cysts developing primarily in the common bile duct are extremely rare. Occasionally, hydatid cysts rupture into the extrahepatic biliary ducts and cause obstruction [1–7]. Two children with intact hydatid cysts in the common bile duct and choledochal cysts were seen during a 2-year period in the Paediatric Surgery Division of the Children's Hospital, Banaras Hindu University, Varanasi. The details of their presentation and operative management are reported.     

Modified Kasai's procedure for a choledochal cyst with a very narrow hilar duct

Excision has been widely recognized as the treatment of choice for choledochal cysts. For biliary reconstruction after cyst excision, we have strongly recommended hepaticoenterostomy at the hepatic hilum with a wide anastomotic stoma to prevent postoperative cholangitis. However, we recently treated two infants in whom a wide anastomotic stoma could not be made due to a narrow hilar duct. Therefore, a hepatic portojejunostomy with Roux-en-Y anastomosis (Kasai's procedure) was performed after cyst excision in both case to permit free drainage of bile. The mucosa of the hilar duct was everted and fixed to the liver parenchyma to prevent stricture formation. Both babies have done well since the surgery.     

腹腔镜胆总管囊肿切除肝管空肠Roux-en-Y吻合手术总结

目的 本研究对腹腔镜胆总管囊肿切除肝管空肠Roux-en-Y吻合手术6年经验进行总结,探讨该技术的近期和远期疗效.方法 从2001年4月至2007年3月,本课题组采用腹腔镜技术治疗先天性胆总管囊肿患儿102例,平均年龄3.2岁.其中13～28d9例,29d～6个月23例,7个月～3岁28例,4～18岁42例.采用四trocars技术完成胆道造影、胆囊和胆总管囊肿壁全层切除;同时利用腹腔镜头对扩张的肝内胆管进行探查;从脐部切口提出空肠,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 102例全部在腹腔镜下完成手术,无中转开放手术者,平均手术时间224min(155～456min),手术中出血5～10ml,无手术中需要输血者.21例患儿合并肝门部肝管狭窄,行肝管扩大成形术;其中1例患儿手术后并发胆漏,持续腹腔引流26d,自然愈合.2例患儿分别于手术后第二天至第五天和第七天并发消化道出血.1例5岁女孩手术后7.5h突发心跳骤停,高血钾(K+10.85mmol/L),死亡.其他98例患儿手术后恢复顺利,手术后3～6d出院.1例患儿于手术后6个月发生空肠肝支梗阻坏死,行坏死肠管切除,二次肝管空肠Roux-Y吻合手术.患儿手术后经3～72个月的随访肝功能正常,无结石和胰腺炎发生.结论 腹腔镜胆总管囊肿切除肝管空肠Roux-en-Y吻合手术是治疗先天性胆总管囊肿可靠的手段,镜下放大的手术视野有利于精确的手术操作,近期和远期疗效良好.手术后早期有必要密切观察血钾的变化.     

先天性胆总管囊肿胰管发育与十二指肠乳头异位的关系

目的十二指肠乳头的开口代表胚胎发育时期肝憩室的发生部位,而胰腺、胆总管和肝脏均起源于肝憩室。前续研究显示先天性胆总管囊肿、胰胆合流异常和十二指肠乳头异位密切相关。本文探讨胰管发育异常和十二指肠乳头异位之间的关系。方法先天性胆总管囊肿患儿118例,胰胆管造影了解其胰胆合流异常、十二指肠乳头异位及胰管发育异常情况,以11例年龄相仿球形红细胞增多症合并胆结石患儿的胆道造影结果为对照组。结果对照组中,11例患儿的十二指肠乳头均位于十二指肠降部。118例先天性胆总管囊肿患儿中,十二指肠乳头开口于降部38例,占32.2%,其余80例患儿,十二指肠乳头开口于降部以远,占67.8%。对于乳头开口于十二指肠降部以远的患儿,合并胰管发育异常者明显高于乳头开口位置正常者(十二指肠降部)(P<0.01)。乳头开口位置正常的先天性胆总管囊肿患儿,合并胰管发育异常仅占23.7%;乳头开口于十二指肠降部以远的患儿合并胰管发育异常仅占49.5%。乳头开口位置正常和开口于十二指肠降部以远的先天性胆总管囊肿患儿,合并胰管扩张的发生率分别为7.9%和28.7%,P<0.05。结论本研究结果表明胰管发育异常是先天性胆总管囊肿的重要病理改变,提示胚胎发育早期肝憩室的发育异常,可能是引起胆道扩张、胰管发育异常和乳头异位的原因。     

Ductoplasty for an aberrant hepatic duct in a choledochal cyst

The confluence of the right and left hepatic ducts at the hepatic hilum frequently shows normal anatomic variations. Choledochal cysts (CC) are also accompanied by similar variations, and devices for free drainage of bile are occasionally required in biliary reconstruction. We present a CC that had an aberrant posterior branch of the right hepatic duct draining into the distal common hepatic duct. A capacious hepaticoduodenostomy at the hilum was performed after joining the hilar and aberrant ducts.     

Excision of a choledochal cyst and simultaneous hepatic lateral segmentectomy

We treated a 4-year-old girl with a choledochal cyst (CC) with bilateral intrahepatic involvement. A severe stricture between the enormously dilated left intrahepatic bile duct and the dilated common hepatic duct was found; this necessitated prophylactic hepatic lateral segmentectomy together with excision of the CC to avoid possible stone formation in the cystically dilated left intrahepatic duct. The choice of the combined procedures was based upon long-term results of other patients in our experience. This is the first such procedure to be reported.     

Pathologic changes in the common bile duct of an experimental model with pancreaticobiliary maljunction without biliary dilatation

Pancreaticobiliary maljunction (PBM), a congenital anomaly, causes regurgitation of pancreatic juice into the biliary tract, where it exerts a hazardous influence. However, changes in the common bile duct (CBD) remain obscure due to a lack of suitable experimental models. Using cats, we have developed an experimental model of PBM without bile-duct dilatation that allows the pure effects of PBM to be studied. Histologic and cellular kinetic changes in the CBD were analyzed in 6 controls and 9 experimental animals that survived for more than 6 months. CBD sections were stained with hematoxylin and eosin and a monoclonal antibody to the proliferating cell nuclear antigen (PCNA). Invaginations of the bile-duct epithelium or parietal sacculi increased, and peribiliary glands were well-developed. PCNA-positive cells significantly increased in the CBD, especially in the parietal sacculi and glands. It is concluded that PBM increases the cell cycle in CBD epithelium and subsequently developed peribiliary glands. These developed glands may be associated with the formation of protein plugs, often seen in patients with PBM. Accepted: 3 May 1999     

Nonrefluxing biliary appendicoduodenostomy for choledochal cyst

A new technique of biliary appendicoduodenostomy along with an antireflux procedure was used for the treatment of a choledochal cyst, with a satisfactory result.