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首页> 外文期刊>Surgical Endoscopy >Laparoscopic resection of congenital choledochal cyst, choledochojejunostomy, and extraabdominal Roux-en-Y anastomosis.
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Laparoscopic resection of congenital choledochal cyst, choledochojejunostomy, and extraabdominal Roux-en-Y anastomosis.

机译：腹腔镜切除先天性胆总管囊肿，胆总管空肠吻合术和腹部Roux-en-Y吻合术。

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摘要

BACKGROUND: The feasibility of laparoscopic resection of choledochal cyst and hepaticojejunostomy in children is still unclear. This report presents the author's experience with a first series of patients. METHODS: Data from 11 consecutive children (median age 17.5 months, SD 22, range 2 to 70) with choledochal cyst scheduled for laparoscopy were collected prospectively. There were nine type I and 2 type V cysts according to Todani's classification. All except one patient had intermittent jaundice or recurrent pancreatitis. The laparoscopic technique included excision of the cyst. A Roux-en-Y anastomosis was constructed after exteriorization of the small bowel via the infraumbilical trocar incision. After repositioning of the bowel an end-to-side hepaticojejunostomy was carried out laparoscopically. RESULTS: The procedures were carried out in nine children without intraoperative events and a median duration of 289 min (SD 62). In two patients, the operation was converted after 60 and 90 min due to a lack of overview at the dorsal margin with problems in separation of the portal vein. Oral food intake was started within 2 days and tolerated well in all except one patient, in whom biliar fluid from the drain led to laparoscopic reevaluation on day 1. A small leak was resutured and the patient was discharged on day 5. In one patient, recurrent cholangitis and a dilated Roux-en-Y loop led to correction of some kinking of the loop via laparotomy after 3 months. All other patients are well with bile-stained stools after a mean follow-up of 13 months. CONCLUSIONS: Laparoscopic resection of congenital choledochal cyst and choledochojejunostomy in children is feasible. We feel that there is a considerable learning curve with the technique. Future studies will have to prove the feasibility of laparoscopic Roux-en-Y bowel anastomosis without the need for bowel exteriorization.
机译：背景：儿童腹腔镜胆总管囊肿切除术和肝空肠吻合术的可行性尚不清楚。该报告介绍了作者在第一批患者中的经历。方法：前瞻性收集连续11例计划进行腹腔镜检查的胆总管囊肿患儿（中位年龄17.5个月，SD 22，范围2至70）的数据。根据Todani的分类，有9个I型和2个V型囊肿。除一名患者外，所有患者均患有间歇性黄疸或复发性胰腺炎。腹腔镜技术包括切除囊肿。通过脐带套管针切口将小肠外化后，便建立了Roux-en-Y吻合术。在重新定位肠后，通过腹腔镜进行端侧肝空肠造口术。结果：该手术是在9名无术中事件的儿童中进行的，中位时间为289分钟（SD 62）。在两名患者中，由于缺乏在背缘的概览以及门静脉分离的问题，在60和90分钟后进行了手术。除一名患者外，所有患者均在2天内开始口服食物，并且对所有患者的耐受性都很好，在该患者中，从排泄口取来的胆汁液导致在第1天进行腹腔镜再评估。在第5天重新排泄少量尿液，该患者出院。复发性胆管炎和Roux-en-Y环扩张导致3个月后通过剖腹手术纠正了环的一些扭结。在平均随访13个月后，所有其他患者的粪便都染有胆汁。结论：腹腔镜切除小儿先天性胆总管囊肿和胆总管空肠吻合是可行的。我们认为该技术存在相当大的学习曲线。未来的研究将必须证明无需进行肠外化手术的腹腔镜Roux-en-Y肠吻合术的可行性。

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