目的 介绍儿童腹腔镜下胆总管囊肿切除、空肠肝管Roux-Y吻合术的初步临床经验,并就如何减少术中风险和术后并发症展开讨论.方法 总结上海交通大学医学院附属新华医院儿外科和上海儿童医学中心外科的61例儿童胆总管囊肿经腹腔镜手术病例.其中男18例,女43例,年龄8 d ～ 14岁,术前均行磁共振胰胆管造影(MRCP)并提示为Ⅰ型胆总管囊肿,囊肿直径1.2 ～ 12 cm,均未作外引流.结果 61例中54例成功经腹腔镜完成囊肿切除、空肠肝总管Roux-Y吻合术,7例分别因囊肿巨大、炎性粘连、出血或技术原因中转开腹.术后出现吻合口漏2例;随访2 ～ 43个月,胰头部囊肿形成2例,存在胰腺炎发作1例,有粘连性肠梗阻2例,均保守治疗后缓解.结论 腹腔镜下儿童胆总管囊肿切除术具有显著的微创手术优点,但需要娴熟的镜下操作技能和经验的积累,减少手术并发症的风险是将该技术在临床推广的重要前提.%Objective To present experiences with laparoscopic resection of choledochal cyst and hepaticoje-junostomy in children, and to discuss how to reduce the intra-operational risk and post-operational complications. Methods Data from sixty-one patients (18 boys and 43 girls, aged from 8 days to 14 years) accepted laparoscopic resection of choledochal cyst were reviewed. All patients were confirmed Type I choledochal cyst by magnetic resonance imaging of biliary tract before operation. The diameter of the cysts was from 1.2 cm to 12 cm. No drainage of the cyst had been made before. Results Fifty-four patients successfully underwent laparoscopic choledochal cyst resection, hepaticojejunostomy, and Roux-en-Y anastomosis. However, 7 patients had to convert to open approaches because of the huge size of cyst, adhesion, bleeding or technically reasons. Two patients had anastomotic leakage postoperative. In 2 months to 43 months postoperative follow-up, 2 patients developed cephalad pancreas cyst, one patient had pancreatitis, and 2 patients had adhesive intestinal obstruction. All of them relieved without re-operation. Conclusions Laparoscopic cholendochal cyst excision with advantage of minimal invasion was effective and safe in children. However, laparoscopic management need well trained and experienced operator. The most important thing is to control the intra- and post-operative risk before widely applied in clinic.
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