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机器人辅助下I型胆总管囊肿切除并Roux-en-Y肝管空肠吻合术重建

Robotic assisted excision of type I choledochal cyst with Roux-en-y hepaticojejunostomy reconstruction.

作者信息

Wang Shin-E, Chen Shih-Chin, Shyr Bor-Uei, Shyr Yi-Ming

机构信息

Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan.

出版信息

Hepatobiliary Surg Nutr. 2017 Dec;6(6):397-400. doi: 10.21037/hbsn.2017.01.15.

Abstract

Choledochal cyst is a relatively rare congenital disease. The current standard treatment of choice for choledochal cyst is complete excision with Roux-en-y hepaticojejunostomy due to possible associated complications if left untreated, such as cholangitis, pancreatitis, cirrhosis, portal hypertension, and biliary malignancy. Traditionally, the resection for choledochal cyst is carried out with open surgery because of complex dissection and bilioenteric reconstruction. Recently, minimal invasive approach has gain wide interest, especially with the use of robotic surgical systems which can facilitate complex minimal access procedures. Herein, we present a case of robotic assisted excision of type I choledochal cyst in a young lady with complete intracorporeal reconstruction of Roux-en-y hepaticojejunostomy. Robotic-assisted surgery can be safely applied to the resection of type I choledochal cyst and also provide a complex suturing technique for reconstruction with Roux-en-y hepaticojejunostomy. Although the total operating time for robot-assisted resection of choledochal cysts and hepaticojejunostomy is relatively long for this initial experience, the young lady and family are pleased with the cosmetic results.

摘要

胆管囊肿是一种相对罕见的先天性疾病。由于胆管囊肿若不治疗可能会引发如胆管炎、胰腺炎、肝硬化、门静脉高压和胆管恶性肿瘤等相关并发症,目前其标准治疗选择是行Roux-en-Y肝空肠吻合术并完整切除。传统上,由于解剖复杂和胆肠重建,胆管囊肿切除术通过开放手术进行。近来,微创方法受到广泛关注,尤其是使用机器人手术系统,其可促进复杂的微创手术。在此,我们报告一例年轻女性I型胆管囊肿机器人辅助切除术,术中行Roux-en-Y肝空肠吻合术完全在体内重建。机器人辅助手术可安全应用于I型胆管囊肿切除,还可为Roux-en-Y肝空肠吻合术重建提供复杂的缝合技术。尽管基于这一初步经验,机器人辅助切除胆管囊肿和肝空肠吻合术的总手术时间相对较长,但这位年轻女性及其家人对美容效果很满意。

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Laparoscopic excision of a choledochal cyst in 82 consecutive patients.82 例连续患者腹腔镜胆总管囊肿切除术。
Surg Endosc. 2013 May;27(5):1648-52. doi: 10.1007/s00464-012-2646-0. Epub 2012 Dec 13.
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Lessons and tips from the experience of pediatric robotic choledochal cyst resection.小儿机器人胆总管囊肿切除术经验中的教训与技巧
J Laparoendosc Adv Surg Tech A. 2012 Jul-Aug;22(6):609-14. doi: 10.1089/lap.2011.0503. Epub 2012 Jun 13.
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Arch Surg. 2003 Mar;138(3):333-9. doi: 10.1001/archsurg.138.3.333.
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