腹腔镜下胆总管囊肿根治术后并发症分析

郑州大学第一附属医院小儿普外(河南省郑州市,450000)

胆总管囊肿; 腹腔镜检查; 手术后并发症

Complications after laparoscopic total cyst with Roux-en-Y hepatoenterostomy for choledochal cyst.
Zhang Ting, Zhang Da, Yang Heying, Wang Jiaxiang, Jia Jia, Wang Qin.

Department of Pediatric Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450000, China.Corresponding author: Zhang Da, Email: wq00893@126.com

Choledochal Cyst; Laparoscopy; Postoperative Complications

DOI: 10.3969/j.issn.1671— 6353.2018.06.015

备注

目的 探讨腹腔镜下胆总管囊肿切除肝管空肠Roux-en-Y吻合术后并发症及防治措施。方法 回顾性分析2012年6月至2016年7月108例腹腔镜下胆总管囊肿切除肝管空肠Roux-en-Y吻合术患儿的临床资料。结果 103例在腹腔镜下成功完成手术,其中3例于术中探查发现1例合并肠旋转不良,1例合并梅克尔憩室,1例合并左侧腹股沟斜疝,均予以矫治; 5例因局部囊壁周围粘连严重、出血多或血管畸形而中转开腹手术。9例术后出现并发症,其中胆瘘4例,胰瘘3例,出血2例。9例出现并发症的患儿中,4例经再次手术治愈,包括3例胆瘘和1例出血患儿。结论 腹腔镜下胆总管囊肿切除肝管空肠Roux-en-Y吻合术的术后并发症与开腹手术类似,其中胆瘘、胰瘘、出血相对常见,为降低术后并发症的发生率,除需充分的术前准备、细致的术后管理以外,还需具备娴熟的手术技巧和丰富的术中处理经验。
Objective To explore the categories and precautions of complications after laparoscopic total cyst with Roux-en-Y hepatoenterostomy for choldedochal cyst in children. Methods Laparoscopic cyst with Roux-en-Y hepatoenterostomy was performed in 108 cases of congenital choledochal cyst from June 2012 to July 2016. Results Laparoscopy was successfully completed in 103 of them.The concurrent conditions of congenital intestinal malrotation(n=1), Meckel's diverticulum(n=1)and left inguinal hernia(n=1)were all cured.Another 5 cases were converted into laparotomy due to heavy inflammation of cyst wall and profuse hemorrhage or vascular malformation.The complications included biliary leakage(n=4), pancreatic fistula(n=3)and hemorrhage(n=2).Exploratory laparotomy was performed for biliary leakage(n=3)and hemorrhage(n=1). Conclusion Some complications are similar to those after conventional operations, such as biliary leakage, pancreatic fistula and hemorrhage.Meticulous intraoperative handling, relevant experiences, thorough preoperative preparations and proper postoperative managements may reduce the occurrence of postoperative complications.