摘要
目的应用腹腔镜微创技术完成晚期胰腺及壶腹周围恶性肿瘤所致阻塞性黄疸的内引流术,从而使一部分高龄、体弱的晚期病人可以承受这种微创的胆肠内引流手术,达到减黄、护肝、提高生活质量的目的。方法腹腔镜下结肠前胆囊体部与空肠间侧侧吻合,空肠与空肠间Bran氏吻合,两个吻合均在腹腔镜下用切割缝合器(Endo-GIA)行侧侧吻合,两吻合口间距为45cm,十二指肠空肠曲与Bran氏吻合口间距为15cm。结果手术25例,术中出血量30～50ml,术后无吻合口瘘发生,术后无呼吸及泌尿系合并症。术后第1天即可离床活动,3～4d排气,术后无体重减轻。黄疸消退、血清总胆红素恢复正常时间为4～6d。结论应用腹腔镜微创技术完成胆肠内引流术,胆肠、肠肠吻合确切,同时具有对病人打击小、全身免疫系统干扰轻等特点,特别适合于不能切除、不能耐受手术的晚期恶性肿瘤病人。
Objective To treat obstructive jaundice induced by advanced pancreas and periampullary adenocarcinoma with laparoscopic minimally invasive technique.The old and weak patients may endure the minimally invasive gallbladder-jejunum internal drainage,in order to attain the aim of lightening jaundice,protecting liver function and improving the living quality.Methods Laparoscopic side-side anastomosis with the jejunum and Bran'anastomosis between jejunum both applied laparoscopic Endo-GIA and anastomosis side by side.The interval of two anastomosis incision is45cm,the interval of the curve of duodenum jejunum and Bran'anastomosis is 15cm.Results There were25cases in the group.The blood loss was 30～50ml.There was no operative complications,including anastomosis leak,respiratory system and urinary system complications.The patients could move out of the bed in the first day after the operation and could leave in three or four days after the operation,there was no weight loss after the operation.The jaundice was lightened and the TBIL of blood serum was normal in 4～6 days after the operation.Conclusion The operation of gallbladder-jejunum internal drainage,gallbladder-jejunum and jejunum-jejunum anastomosis under laparoscope is definite,and it has the advantages of less injury and less immune system disorders.It especially suits for the patients who can not endure the operations and the tumor can not be resected.
出处
《中国实用医药》
2007年第8期21-22,共2页
China Practical Medicine
关键词
腹腔镜
胆囊空肠内引流术
胰腺及壶腹周围晚期恶性肿瘤
阻塞性黄疸
Laparoscopoe
Gallbladder-jejunum internal drainage
Advanced pancreas and periampullary adenocarcinoma
Obstructive jaundice
