重视腹腔镜技术治疗复合型胆管囊肿手术规划与术中处理
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摘要
先天性胆管囊肿是一种胆总管单独或联合肝内胆管扩张的结构发育畸形,多伴有胆胰管合流异常,最常表现为胆总管囊状或梭形扩张,累及肝内胆管囊状扩张或副肝管畸形则被称为复合型胆管囊肿。随着微创技术的进步,腹腔镜胆总管囊肿切除、胆道重建手术在国内广泛开展,同时也开始应用到复合型胆管囊肿肝门胆管畸形的治疗中,但如果术中处理不当,容易发生血管误伤、胆肠吻合引流不畅等情况,继而导致反复胆管炎发作、肝内胆管结石等并发症,应予以重视。
Congenital biliary cyst is a structural abnormality of common bile duct or combined with intrahepatic bile duct dilatation.The most common manifestation is cystic or fusiform dilatation of common bile duct.A complex bile duct cyst involves intrahepatic biliary cystic dilatation or parahepatic duct malformation.With the advancement of mini-invasive techniques,laparoscopic choledochal cyst resection and biliary reconstruction are widely performed domestically for hepatic hilar bile duct malformation in complex bile duct cysts.However,if intraoperative handling is not properly implemented,vascular injuries are prone to occur.Accidental injury,improper biliary anastomosis and drainage may lead to such complications as an onset of repeated cholangitis and a formation of intrahepatic bile duct stones.
Congenital biliary cyst is a structural abnormality of common bile duct or combined with intrahepatic bile duct dilatation.The most common manifestation is cystic or fusiform dilatation of common bile duct.A complex bile duct cyst involves intrahepatic biliary cystic dilatation or parahepatic duct malformation.With the advancement of mini-invasive techniques,laparoscopic choledochal cyst resection and biliary reconstruction are widely performed domestically for hepatic hilar bile duct malformation in complex bile duct cysts.However,if intraoperative handling is not properly implemented,vascular injuries are prone to occur.Accidental injury,improper biliary anastomosis and drainage may lead to such complications as an onset of repeated cholangitis and a formation of intrahepatic bile duct stones.
引文
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3 Li S,Wang W,Yu Z,et al.Laparoscopically assisted extrahepatic bile duct excision with ductoplasty and a widened hepaticojejunostomy for complicated hepatobiliary dilatation[J].Pediatr Surg Int,2014,30(6):593-598.DOI:10.1007/s00383-014-3501-2.
4苏琳,董蒨,张虹,等.计算机辅助手术系统在先天性胆管扩张症[J].临床小儿外科杂志,2016,15(2):140-143.DOI:10.3969/j.issn.1671-6353.2016.02.012.Su L,Dong Q,Zhang H,et al.Application of compute-aided surgical syste in congenital bile duct dilatations[J].Pediatr Surg Int,2016,15(2):140-143.DOI:10.3969/j.issn.1671-6353.2016.02.012.
5中华医学会小儿外科学分会腔镜外科学组.腹腔镜胆总管囊肿手术操作指南(2017版)[J].中华小儿外科杂志,2017,38(7):485-494.DOI:10.3760/cma.j.issn.0253-3006.2017.07.002.Endoscopic Surgical Group,Branch of Pediatric Surgery,Chinese Medical Association:Guidelines of Surgical Handling for Laparoscopic choledochal cysts(2017 Edition)[J].Chin J Pediatric Surg,2017,38(7):485-494.DOI:10.3760/cma.j.issn.0253-3006.2017.07.002.
6 Kawarada Y,Das BC,Tabata M,et al.Surgical treatment of type IV choledochal cysts[J].J Hepatobiliary Pancreat Surg,2009,16(5):684-687.DOI:10.1007/s00534-009-0052-3.
7刁美,李龙,叶茂,等.腹腔镜与开放胆总管囊肿术后胆道梗阻二次手术的对比研究[J].中华小儿外科杂志,2018,39(4):279-284.DOI:10.3760/cma.j.issn.0253-3006.2018.04.009.Diao M,Li L,Ye M,et al.Comparative study of re-operation for postoperative bile duct obstruction after laparoscopic and open procedures for choledochal cysts[J].Chin J Pediatric Surg,2018,39(4):279-284.DOI:10.3760/cma.j.issn.0253-3006.2018.04.009.
8 Diao M,Li L,Zhang JS,et al.Laparoscopic-assisted clearance of protein plugs in the common channel in children with choledochal cysts[J].J Pediatr Surg,2010,45(10):2099-2102.
9沈阳,毛杰,颜禄斌,等.改良胆肠袢式吻合术在小儿先天性胆总管囊状扩张症中的应用[J].中华小儿外科杂志,2011,32(12):896-899.DOI:10.3760/cma.j.issn.0253-3006.2011.12.006.Shen Y,Mao J,Yan LB,etc.Application of modified biliary-intestinal loop anastomosis in congenital choledochal cystic dilatations[J].Chin J Pediatric Surg,2011,32(12):896-899.DOI:10.3760/cma.j.issn.0253-3006.2011.12.006.
10 Diao M,Li L,Zhang JZ,et al.A shorter loop in Roux-Y hepatojejunostomy reconstruction for choledochal cysts is equally effective:preliminary results of a prospective randomized study[J].J Pediatr Surg,2010,45(4):845-847.
2 Todani T,Watanabe Y,Toki A,et al.Classification of congenital biliary cystic disease:special reference to type Ic and IV-A cysts with primary ductal stricture[J].J Hepatobiliary Pancreat Surg,2003,10:340-344.
3 Li S,Wang W,Yu Z,et al.Laparoscopically assisted extrahepatic bile duct excision with ductoplasty and a widened hepaticojejunostomy for complicated hepatobiliary dilatation[J].Pediatr Surg Int,2014,30(6):593-598.DOI:10.1007/s00383-014-3501-2.
4苏琳,董蒨,张虹,等.计算机辅助手术系统在先天性胆管扩张症[J].临床小儿外科杂志,2016,15(2):140-143.DOI:10.3969/j.issn.1671-6353.2016.02.012.Su L,Dong Q,Zhang H,et al.Application of compute-aided surgical syste in congenital bile duct dilatations[J].Pediatr Surg Int,2016,15(2):140-143.DOI:10.3969/j.issn.1671-6353.2016.02.012.
5中华医学会小儿外科学分会腔镜外科学组.腹腔镜胆总管囊肿手术操作指南(2017版)[J].中华小儿外科杂志,2017,38(7):485-494.DOI:10.3760/cma.j.issn.0253-3006.2017.07.002.Endoscopic Surgical Group,Branch of Pediatric Surgery,Chinese Medical Association:Guidelines of Surgical Handling for Laparoscopic choledochal cysts(2017 Edition)[J].Chin J Pediatric Surg,2017,38(7):485-494.DOI:10.3760/cma.j.issn.0253-3006.2017.07.002.
6 Kawarada Y,Das BC,Tabata M,et al.Surgical treatment of type IV choledochal cysts[J].J Hepatobiliary Pancreat Surg,2009,16(5):684-687.DOI:10.1007/s00534-009-0052-3.
7刁美,李龙,叶茂,等.腹腔镜与开放胆总管囊肿术后胆道梗阻二次手术的对比研究[J].中华小儿外科杂志,2018,39(4):279-284.DOI:10.3760/cma.j.issn.0253-3006.2018.04.009.Diao M,Li L,Ye M,et al.Comparative study of re-operation for postoperative bile duct obstruction after laparoscopic and open procedures for choledochal cysts[J].Chin J Pediatric Surg,2018,39(4):279-284.DOI:10.3760/cma.j.issn.0253-3006.2018.04.009.
8 Diao M,Li L,Zhang JS,et al.Laparoscopic-assisted clearance of protein plugs in the common channel in children with choledochal cysts[J].J Pediatr Surg,2010,45(10):2099-2102.
9沈阳,毛杰,颜禄斌,等.改良胆肠袢式吻合术在小儿先天性胆总管囊状扩张症中的应用[J].中华小儿外科杂志,2011,32(12):896-899.DOI:10.3760/cma.j.issn.0253-3006.2011.12.006.Shen Y,Mao J,Yan LB,etc.Application of modified biliary-intestinal loop anastomosis in congenital choledochal cystic dilatations[J].Chin J Pediatric Surg,2011,32(12):896-899.DOI:10.3760/cma.j.issn.0253-3006.2011.12.006.
10 Diao M,Li L,Zhang JZ,et al.A shorter loop in Roux-Y hepatojejunostomy reconstruction for choledochal cysts is equally effective:preliminary results of a prospective randomized study[J].J Pediatr Surg,2010,45(4):845-847.