Diao Mei,Li Long.Surgical essentials and techniques of transumbilical single incision laparoscopy for choledochal cysts[J].Journal of Clinical Pediatric Surgery,2019,18(07):536-541.[doi:10.3969/j.issn.1671-6353.2019.07.003]
经脐单切口腹腔镜技术治疗胆总管囊肿的手术要点及技巧
- Title:
- Surgical essentials and techniques of transumbilical single incision laparoscopy for choledochal cysts
- Keywords:
- Laparoscopes; Choledochal Cyst
- 分类号:
- R726;R616.5;R575.7
- 摘要:
- 近年来，为实现视觉无瘢痕的微创目标，经脐单切口腹腔镜手术逐步在小儿外科应用。难点包括：第一，器械和腔镜几乎平行，如何建立器械成角减少碰撞；第二，缺少一助辅助，游离和吻合困难；第三，脐部切口疝和感染。通过套筒隧道建立及放置，接力式悬吊等技术改进，成功使用传统器械完成经脐单切口腹腔镜胆总管囊肿根治术，并推广应用于各种复杂型胆总管囊肿，包括新生儿，巨大胆总管囊肿，二次/二期手术，穿孔胆总管囊肿。大样本对比研究证实其安全有效，疗效和传统四孔腹腔镜手术相似，且达到视觉无瘢痕的目标，可作为胆总管囊肿外科治疗选择之一。
- Abstract:
- In recent years, single-incision laparoscopy has been adopted in pediatric surgery to achieve the advanced goal of minimal invasive surgery, i.e. visual scarlessness. The technical challenges included:1) Difficult triangulation induced by in-line placement of telescope and instruments; 2) difficult dissection and anastomosis due to lack of assistant; 3) Umbilical wound hernia and infection. Via a series of technical improvements, e.g. instrument placements, retraction suture etc., the single-incision laparoscopy definitive surgery has been successfully carried out in children with choledochal cysts (CDC). It has been extended to be used in treatment of complicated CDCs, including neonatal CDCs, giant CDCs, redo-or second-stage surgery, perforated CDCs. The Comparative study verified that its operative time and effectiveness were similar to those of conventional laparoscopic definitive surgery in CDC children. Furthermore, it achieved "visual scarlessness". It provides a viable surgical treatment option for CDCs.
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备注/Memo
收稿日期:2019-5-24。
基金项目:北京市卫生系统高层次卫生技术人才培养计划（编号：2014—3—071）；首都临床特色应用研究特色课题（编号：Z171100001017222）；北京市医院管理局儿科学科协同发展中心儿科专项重点项目（编号：XTZD20180304）
通讯作者:李龙,Email:lilong23@126.com;刁美,Email:psps3001@hotmail.com