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目的探讨微小切口肝门空肠Roux-en-Y吻合术的可行性和疗效。方法 2008年3月～2010年6月腹腔镜下胆道造影或探查术确诊Ⅲ型胆道闭锁82例,行微小切口肝门空肠Roux-en-Y吻合术。上腹横切口,4把S拉钩分别在上下左右对拉,暴露肝门,游离切除胆囊,彻底游离切除肝门纤维块,行肝门空肠吻合。结果 82例均完成微小切口肝门空肠Roux-en-Y吻合手术。手术切口长度平均4.2 cm(4～4.5 cm);开腹手术操作时间平均71.8 min(55～90 min);平均出血量8.3 ml(5～20 ml),无术中输血者。均未放置腹腔引流。术后24～48 h拔除胃管,48～72 h进食。无围手术期死亡病例。术后第2天消化道出血1例,术后切口裂开2例。82例随访6～18个月,平均10.5月,术后4周获得胆汁引流率(直接胆红素降至正常水平或较术前下降超过60%)占69.5%(57/82),术后胆管炎发作3次以上占29.3%(24/82)。结论微小切口肝门空肠Roux-en-Y吻合术治疗胆道闭锁,可以不将肝脏拖出腹腔外进行吻合,避免对患儿循环系统的严重影响,同时直视下肝门空肠吻合可以保证吻合确切在门静脉后方,手术安全可靠。
Objective To investigate the feasibility and efficacy of Roux-en-Y anastomosis with minimal incision of hepatic portal jejunum. Methods From March 2008 to June 2010, 82 cases of type Ⅲ biliary atresia were diagnosed by laparoscopic cholangiography or exploration, and Roux-en-Y anastomosis was performed with minimal incision of hepatic portal jejunum. Abdominal transverse incision, 4 S pull hook respectively in the upper and lower left and right on the pull, exposing the liver door, free removal of the gallbladder, completely free removal of the hepatic fiber block, the line of hepatic jejunum anastomosis. Results All the 82 cases were performed Roux-en-Y anastomosis with minimal incision of hepatic portal jejunum. The average length of surgical incision was 4.2 cm (ranged from 4.5 cm). The mean operative time of open surgery was 71.8 min (ranged from 55 to 90 min). The mean amount of bleeding was 8.3 ml (5-20 ml). There was no intraoperative blood transfusion. No abdominal drainage were placed. Twenty-four to forty-eight hours after the removal of the gastric tube, 48 to 72 h to eat. No perioperative deaths. One patient had digestive tract hemorrhage on the second day after operation, and two patients had incision after incision. 82 cases were followed up for 6 to 18 months with an average of 10.5 months. The biliary drainage rate (direct bilirubin decreased to normal or more than 60% compared with preoperative) accounted for 69.5% (57/82) after 4 weeks. Cholangitis more than 3 times accounted for 29.3% (24/82). Conclusion Roux-en-Y anastomosis with minimal incision of the hepatic door and jejunum can treat the biliary atresia without pulling the liver out of the abdomen for anastomosis to avoid the serious impact on the circulatory system in children. At the same time, the anastomosis of the portal hepatic jejunum can ensure the anastomosis Behind the portal vein, the operation is safe and reliable.