Tang Shaotao,Chang Xiaopan.Anastomotic stenosis after laparoscopic choledochal cyst surgery[J].Journal of Clinical Pediatric Surgery,2019,18(07):542-544.[doi:10.3969/j.issn.1671-6353.2019.07.004]
腹腔镜下胆总管囊肿切除术后吻合口狭窄问题
- Title:
- Anastomotic stenosis after laparoscopic choledochal cyst surgery
- Keywords:
- Laparoscopes; Choledochal Cyst
- 分类号:
- R726;R616.5;R575.7
- 摘要:
- 腹腔镜囊肿切除肝门空肠吻合术用于治疗胆总管囊肿已有20余年历史,操作方法也趋于成熟。目前,随着产前检出率的提高和手术时机的提前,腹腔镜术后吻合口狭窄成为患儿接受再次手术的最主要原因。为达到更理想的手术疗效,笔者结合临床工作经验,归纳了腹腔镜胆总管囊肿近端切除术和吻合术中的注意事项。
- Abstract:
- Laparoscopic cystectomy for hepatic jejunal anastomosis has been used for the treatment of choledochal cysts for more than 20 years, and the method of operation tends to be mature. At present, with the increase of prenatal detection rate and the timing of surgery, anastomotic stenosis after laparoscopic surgery is the most important cause of reoperation. In order to achieve better surgical results, the author combined with clinical work experience, summarized the precautions in the proximal resection and anastomosis of laparoscopic common bile duct cyst.
参考文献/References:
1 Farello GA,Cerofolini A,Rebonato M,et al.Congenital choledochal cyst:video-guided laparoscopic treatment[J].Surg Laparosc Endosc,1995,5(5):354-358.
2 Diao M,Li L,Cheng W.Recurrence of biliary tract obstructions after primary laparoscopic hepaticojejunostomy in children with choledochal cysts[J].Surg Endosc,2016,30(9):3910-3915.DOI:10.1007/s00464-015-4697-5.
3 Sheng Q,Lv Z,Xu W,et al.Reoperation After Cyst Excision with Hepaticojejunostomy for Choledochal Cysts:Our Experience in 18 Cases[J].Med Sci Monit,2017,23:1371-1377.DOI:10.12659/msm.900313.
4 Kim JH,Choi TY,Han JH,et al.Risk factors of postoperative anastomotic stricture after excision of choledochal cysts with hepaticojejunostomy[J].J Gastrointest Surg,2008,12(5):822-828.DOI:10.1007/s11605-007-0415-5.
5 Kim JW,Moon SH,Park DH,et al.Course of choledochal cysts according to the type of treatment[J].Scand J Gastroenterol,2010,45(6):739-745.DOI:10.3109/00365521003675054.
6 Cho MJ,Hwang S,Lee YJ,et al.Surgical experience of 204 cases of adult choledochal cyst disease over 14 years[J].World J Surg,2011,35(5):1094-1102.DOI:10.1007/s00268-011-1009-7.
7 Senthilnathan P,Patel ND,Nair AS,et al.Laparoscopic Management of Choledochal Cyst-Technical Modifications and Outcome Analysis[J].World J Surg,2015,39(10):2550-2556.DOI:10.1007/s00268-015-3111-8.
8 Yeung F,Chung PH,Wong KK,et al.Biliary-enteric reconstruction with hepaticoduodenostomy following laparoscopic excision of choledochal cyst is associated with better postoperative outcomes:a single-centre experience[J].Pediatr Surg Int,2015,31(2):149-153.DOI:10.1007/s00383-014-3648-x.
9 Wang DC,Liu ZP,Li ZH,et al.Surgical treatment of congenital biliary duct cys[J]t.BMC Gastroenterol,2012,12:29.DOI:10.1186/1471-230X-12-29.
10 Jung K,Han HS,Cho JY,et al.Is preoperative subclassification of type I choledochal cyst necessary?[J].Korean J Radiol,2012,13:112-116.DOI:10.3348/kjr.2012.13.S1.S112.
11 Narayanan SK,Chen Y,Narasimhan KL,et al.Hepaticoduodenostomy versus hepaticojejunostomy after resection of choledochal cyst:a systematic review and meta-analysis[J].J Pediatr Surg,2013,48(11):2336-2342.DOI:10.1016/j.jpedsurg.2013.07.020.
12 Qiao G,Li L,Li S,et al.Laparoscopic cyst excision and Roux-Y hepaticojejunostomy for children with choledochal cysts in China:a multicenter study[J].Surg Endosc,2015,29(1):140-144.DOI:10.1007/s00464-014-3667-7.
13 Tang ST,Yang Y,Wang Y,et al.Laparoscopic choledochal cyst excision,hepaticojejunostomy,and extracorporeal Roux-en-Y anastomosis:a technical skill and intermediate-term report in 62 cases[J].Surg Endosc,2011;25(2):416-422.DOI:10.1007/s00464-010-1183-y.
14 Kim NY,Chang EY,Hong YJ,et al.Retrospective assessment of the validity of robotic surgery in comparison to open surgery for pediatric choledochal cyst[J].Yonsei Med J,2015,56:737-743.DOI:10.3349/ymj.2015.56.3.737.
15 Hong L,Wu Y,Yan Z,et al.Laparoscopic surgery for choledochal cyst in children:a case review of 31 patients[J].Eur J Pediatr Surg,2008,18:67-71.DOI:10.1055/s-2008-1038486.
16 Lee KH,Tam YH,Yeung CK,et al.Laparoscopic excision of choledochal cysts in children:an intermediate-term report[J].Pediatr Surg Int,2009,25:355-360.DOI:10.1007/s00383-009-2343-9.
17 Nguyen TL,Hien PD,le Dung A,et al.Laparoscopic repair for choledochal cyst:lessons learned from 190 cases[J].J Pediatr Surg,2010,45:540-544.DOI:10.1016/j.jpedsurg.2009.08.013.
18 Diao M,Li L,Cheng W.Laparoscopic versus open Rouxen-Y hepatojejunostomy for children with choledochal cysts:intermediate-term follow-up results[J].Surg Endosc,2011,25:1567-1573.DOI:10.1007/s00464-010-1435-x.
19 Liem NT,Pham HD,le Dung A,et al.Early and intermediate outcomes of laparoscopic surgery for choledochal cysts with 400 patients[J].J Laparoendosc Adv Surg Tech,2012,22(6):599-603.DOI:10.1089/lap.2012.0018.
20 Wang B,Feng Q,Mao JX,et al.Early experience with laparoscopic excision of choledochal cyst in 41 children[J].J Pediatr Surg,2012,47:2175-2178.DOI:10.1016/j.jpedsurg.2012.09.004.
21 Jang JY,Yoon YS,Kang MJ,et al.Laparoscopic excision of a choledochal cyst in 82 consecutive patients[J].Surg Endosc,2013,27:1648-1652.DOI:10.1007/s00464-012-2646-0.
22 Alizai NK,Dawrant MJ,Najmaldin AS.Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children[J].Pediatr Surg Int,2014,30:291-294.DOI:10.1007/s00383-013-3459-5.
23 Gander JW,Cowles RA,Gross ER,et al.Laparoscopic excision of choledochal cysts with total intracorporeal reconstruction[J].J Laparoendosc Adv Surg Tech A,2010,20:877-881.DOI:10.1089/lap.2010.0123.
24 Kemmotsu H,Mouri T,Muraji T.Congenital stenosis of the hepatic duct at the porta hepatis in children with choledochal cyst[J].J Pediatr Surg,2009,44:512-516.DOI:10.1016/j.jpedsurg.2008.06.011.
25 Watanabe Y,Toki A,Todani T.Bile duct cancer developed after cyst excision for choledochal cyst[J].J Hepatobiliary Pancreat Sci,1999,6(3):207-212.
26 Liu YB,Wang JW,Devkota KR,et al.Congenital choledochal cysts in adults:twenty-five-year experience[J].Chin Med J (Engl),2007,120(16):1404-1407.
27 Stringer MD.Laparoscopic management of choledochal cysts:is a keyhole view missing the big picture?[J].Pediatr Surg Int,2017,33(6):651-655.DOI:10.1007/s00383-017-4089-0.
28 Ohtsuka H,Fukase K,Yoshida H,et al.Long-term outcomes after extrahepatic excision of congenital choladocal cysts:30 years of experience at a single center[J].Hepatogastroenterology,2015,62(137):1-5.
29 Lee SE,Jang JY.Development of biliary malignancy after cyst excision for congenital choledochal cysts:what should we do?[J].J Gastroenterol Hepatol,2013,28:210-212.DOI:10.1111/jgh.12079.
30 Jung K,Han HS,Cho JY,et al.Is preoperative subclassification of type I choledochal cyst necessary?[J].Korean J Radiol,2012,13:112-116.DOI:10.3348/kjr.2012.13.S1.S112.
31 Dutta HK.Hepatic lobectomy and mucosectomy of intrahepatic cyst for type Ⅳ-A choledochal cyst[J].J Pediatr Surg,2012,47(11):2146-2150.DOI:10.1016/j.jpedsurg.2012.07.008.
32 Perdikakis E,Chryssou EG,Koulentaki M,et al.Assessment of a postoperative anastomotic stricture following correction surgery of a type IVa choledochal cyst using Gd-EOB-DTPA-enhanced magnetic resonance cholangiography[J].Clin J Gastroenterol,2011,4(6):396-400.DOI:10.1007/s12328-011-0261-6.
33 Chang X,Zhang X,Xiong M,et al.Laparoscopic-assisted cyst excision and ductoplasty plus widened portoenterostomy for choledochal cysts with a narrow portal bile duct[J].Surg Endosc,2019,33(6):1998-2007.DOI:10.1007/s00464-018-06635-4.
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备注/Memo
收稿日期:2019-6-10。
基金项目:卫计委公益性行业科研专项基金(编号:201402007)
通讯作者:汤绍涛,Email:tshaotao83@126.com