Liem Nguyen Thanh, Dung Le Anh, Son Tran Ngoc
Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam.
J Laparoendosc Adv Surg Tech A. 2009 Apr;19 Suppl 1:S87-90. doi: 10.1089/lap.2008.0169.supp.
To report the technical details and early outcomes of complete laparoscopic cyst excision and hepaticoduodenostomy for choledochal cyst.
The operation was performed using four ports. The cystic duct was identified and divided. The liver was elevated by two stay sutures: one on the round ligament, and the other on the distal cystic duct. The choledochalcyst was isolated and removed completely and the duodenum was mobilized. Hepaticoduodenostomy was constructed 2 cm distal to the pylorus using two running sutures with 5-0 polydioxane sutures.
From January to December 2007, 74 patients were operated. There were 59 girls and 15 boys. Ages ranged from 2.5 months to 16 years old. The diameter of the cyst ranged from 10 mm to 184 mm. The operating time ranged from 90 minutes to 340 minutes (mean: 186 minutes). Conversion to open surgery was required in one patient. Blood transfusion was required in four patients. Postoperative anastomotic leakage occurred in three patients, resolving spontaneously in two patients and requiring a second operation in the third.Postoperative hospital stay ranged from 4 days to 21 days (average: 6.6 days). Follow-up from 3 months to 12 months was obtained in 56 patients (75.5%). Of these patients, cholangitis occurred in three patients (5.3%) and gastritis due to bilious reflux in eight patients (14.3%).
Laparoscopic complete cyst excision and hepaticoduodenostomy is a safe and physiologic procedure for choledochal cyst.
报告完全腹腔镜下胆总管囊肿切除及肝十二指肠吻合术的技术细节和早期疗效。
采用四孔法进行手术。识别并切断胆囊管。用两根牵引缝线提起肝脏：一根缝于圆韧带，另一根缝于胆囊管远端。分离并完全切除胆总管囊肿，游离十二指肠。在幽门远端2 cm处用5-0聚二氧六环缝线连续缝合构建肝十二指肠吻合术。
2007年1月至12月，74例患者接受手术。其中女孩59例，男孩15例。年龄范围为2.5个月至16岁。囊肿直径为10 mm至184 mm。手术时间为90分钟至340分钟（平均：186分钟）。1例患者转为开腹手术。4例患者需要输血。3例患者发生术后吻合口漏，2例患者自行缓解，第3例患者需要再次手术。术后住院时间为4天至21天（平均：6.6天）。56例患者（75.5%）获得了3个月至12个月的随访。在这些患者中，3例患者（5.3%）发生胆管炎，8例患者（14.3%）发生胆汁反流性胃炎。
腹腔镜下完全囊肿切除及肝十二指肠吻合术是治疗胆总管囊肿的一种安全且符合生理的手术方法。
