Schöb O, Schlumpf R, Schmid R, Meyenberger C, Largiadèr F
Departement Chirurgie, Universitätsspital, Zürich.
Schweiz Med Wochenschr. 1994 Oct 15;124(41):1813-20.
In order to avoid laparotomy in patients with biliary and/or gastric outlet obstruction due to inoperable carcinoma of the pancreas, the feasibility of minimal invasive double bypass operation was evaluated in 20 pigs. In model A (n = 10) biliary bypass was performed using a Roux-en-Y loop for cholecystojejunostomy after previous choledochal clip occlusion. In mod-el B (n = 10) an additional Roux-en-Y loop was placed to the stomach after transection and closure of the duodenum.
Model A showed functioning biliary bypass with patent and leakfree anastomoses at necropsy at day 28. In model B nine of ten had a normal functioning double bypass. One pig was sacrificed at day 6 due to necrotic Roux-en-Y loop.
Laparoscopic biliary and gastroenteral bypass is feasible and safe. Laparoscopic Roux-en-Y loop technique considerably widens the spectrum of minimal invasive visceral surgery.
为避免因无法手术切除的胰腺癌导致胆道和/或胃出口梗阻的患者接受剖腹手术，对20头猪进行了微创双旁路手术的可行性评估。在模型A（n = 10）中，在先前胆总管夹闭后，使用Roux-en-Y袢进行胆囊空肠吻合术以建立胆道旁路。在模型B（n = 10）中，在横断并闭合十二指肠后，将另一个Roux-en-Y袢置于胃上。
模型A在第28天尸检时显示胆道旁路功能良好，吻合口通畅且无渗漏。在模型B中，十头中有九头双旁路功能正常。一头猪因Roux-en-Y袢坏死在第6天被处死。
腹腔镜胆道和胃肠旁路手术是可行且安全的。腹腔镜Roux-en-Y袢技术大大拓宽了微创内脏手术的范围。
