【摘要】 目的　探索腹腔镜胆囊空肠吻合术的技术可行性和微创治疗效果 .方法　选取中型猪 10只 ,在腹腔镜下或腹腔镜辅助下行胆囊空肠吻合术 .术前术后监测肝功能 ,包括转氨酶、转肽酶、碱性磷酸酶等 ,术后监测体重变化 ;术后半个月处死动物 ,了解吻合口的大小及愈合情况 .5例晚期胰腺癌经腹腔镜和腹腔镜超声探查分期后行腹腔镜胆囊空肠吻合及胃空肠吻合术 ,其中 3例采用吻合器、2例行手工缝合完成手术 .结果　动物实验组 2例在腹腔镜辅助下行胆囊空肠吻合术及空肠Braun’s吻合术 .第 1例因术中未行气管插管而致术中缺氧 ,手术完成后 4小时死亡 .8例行腹腔镜胆囊空肠吻合术 ,手术历时 12 0～ 180分钟 ,平均 15 0分钟 .存活动物术前术后肝功能各项指标无明显变化 (p>0 .0 5 ) ,术后猪只的体重增加与正常猪相仿 .处死动物后检查胆肠吻合直径介于 17mm± 3.5mm ,空肠Braun’s吻合口直径为 2 2mm± 4 .2mm ,吻合口生长良好 ,未见吻合瘘 .5例病人腹腔镜手术均顺利完成 ,平均手术时间12 0分钟 ,平均住院 7天 ,无腹腔镜手术并发症 ,平均随访 8个月生存良好 .结论　腹腔镜胆肠吻合术或其辅助下的胆肠吻合术技术安全可行 ,可作为不能手术切除的晚期胰腺肿瘤有效的微创姑息治疗新途径更多还原

【Abstract】 Objective To explore the feasibility of laparoscopic cholecystojejunostomy and gastrojejunostomy in a porcine model and the effects of such minimally invasive surgery on the patients with unresectable pancreatic cancer. Methods Laparoscopic or laparoscopic-assisted cholecystojejunostomies were performed on 10 middle sized porcines, pre and postoperative liver functions including ALT,ALP,T-BIL etc, and body weight were evaluated.The porcines were killed at 15 days postoperatively in order to evaluate the conditions of anastomosis. Clinically 5 patients with unresectable pancreatic cancer determined by laparoscopic staginging with LUS were performed on laparoscopic cholecystojejunostomy (in all five cases) and gastrojejunostomy (in two cases), with the anastomosis completed by linear cutter in three cases and hand-sutured techniques in two cases. Results In animal group, laparoscopic assisted cholecystojejunostomy and Braun’s anastomosis were performed in 2 porcines, the orther 8 porcines were performed on laparoscopic cholecystojejunostomy .The operation times were 120～180 min (average 150 min).There were no significant changes in liver function pre-and postoperatively (p>0.05). The diameter of cholecystojejunostomy anastomosis were 17mm±3.5mm, and jejunum Braun’s anastomosis were 22mm±4.2mm, without occurrence of leakage. The laparoscopic operations were successfully performed on 5 patients with the operation time of average 120 min, hospitalization of average 7 dasys, and without operative complications. All patients survive well during the follow-up of average 8 months. Conclusions Laparoscopic or laparoscopic-assisted cholecystojejunostomy provides a safe and efficient minimally invasive method for advanced unresectable pancreatic malignancies.更多还原