微创（腹腔镜）治疗胆总管囊肿！

小儿外科王磊医生

{"id":12167019,"nickname":"小儿外科王磊医生","head_img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/12167019\/15b0e62e-0aae-4cfa-896c-ebfbc19ed9ac.jpg","column_visit":3888,"signature":"The buck stops here!","favorite_count":1,"follow_count":5,"follower_count":48,"famous_type":0,"autoplay_music":1,"text_preference":2,"client_type":1,"reward_word":"如果喜欢我的作品，请打赏鼓励哦！","member_type":0,"wechat_id":"ojq1tt4UsZbJe4VNX8JVdEC0Kk8w","country":"中国","province":"山东","city":"泰安","career":null,"birthday":19820228,"gender":1,"reg_time":1492750902,"e_id":"","bedge_img":"","label_img":"","review_level":1,"enable_reward_switch":false,"enable_water_mark_switch":1,"plainNickname":"小儿外科王磊医生","member_status":2,"member_img":"https:\/\/ss2.meipian.me\/app\/member\/icon\/member2.png","ext":null,"phone_num":"186****1495","head_attach_img":null,"badge":null,"onlive":false,"qualification":null,"biz_info":{"is_biz_user":false,"share_domains":[]},"headwear":{"icon":"","animation":"https:\/\/ss2.meipian.me\/app\/static\/headwear\/baiwanlingxiu.json","config":{"replace":[{"search":"0阅读","replace":"5.5万阅读"}]},"param":{"n":54708,"num_desc":"member_only:visit_count"}},"cover_img_url":"","weibo_id":"","vwen_id":"0f5244da6c5d8927df66ba249ecca606","im_id":"6fc41d622bdc70deb79aa90a40a426f3","yx_im_token":"","last_visit_time":1751949795,"ip_address":"112.245.48.74","device_id":"30ef0dba08fb4e8fab3416c56ff42d5b","reviewer":0,"review_time":0,"account_state":0,"balance":1658,"last_contribution_time":0,"member_expire_time":0,"member_qq_group":0,"web_has_login":0,"longtitude":"117.1405200","latitude":"36.2002700","last_client_type":1,"level":0,"province_user":null,"city_user":null,"user_id":12167019,"qq_id":"","apple_id":"","badge_img_url":"","reward_url":"https:\/\/www.meipian.cn\/wap\/reward\/view\/index.html?mask_id=mpa20a2&author_user_id=12167019&article_title=%E5%BE%AE%E5%88%9B%EF%BC%88%E8%85%B9%E8%85%94%E9%95%9C%EF%BC%89%E6%B2%BB%E7%96%97%E8%83%86%E6%80%BB%E7%AE%A1%E5%9B%8A%E8%82%BF%EF%BC%81","memo_name":""}

[{"img_height":196,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/12167019\/655b8a93ab754bcfa550ffe2db15d3b7__jpg.heic","img_width":602,"text":"<h1><span style=\"line-height: 1.5;\">　　\"<\/span><span style=\"color: rgb(237, 35, 8);\"><b><u>微创<\/u><\/b><\/span><span style=\"line-height: 1.5;\">\"单从字面意思来看就是其优势之一，微创手术有损伤小、美观、术后患儿恢复快等优势，但对于家长来说，其实最关注的是疗效，没有好的治疗效果，无论是开大刀还是微小切口小创伤，都是没有意义的。<\/span><\/h1><h1><b><u style=\"color: rgb(237, 35, 8);\">    近日， 泰安市妇幼保健院（市儿童医院）外一科发现此类患儿较前增多。外一科团队提醒大家：小儿胆总管囊肿，用微创治疗优势更加明显！<\/u><\/b><\/h1>","watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvMTIxNjcwMTkvNjU1YjhhOTNhYjc1NGJjZmE1NTBmZmUyZGIxNWQzYjdfX2pwZy5oZWlj\/nickname\/5bCP5YS_5aSW56eR546L56OK5Yy755Sf\/userid\/MTIxNjcwMTk=\/sign\/81031fe2c7b776acbfa605b804ff399b"},{"img_height":250,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/12167019\/c9f26e0a1be24f7f9d3834ff14303c4c__jpg.heic","img_width":302,"text":"<h1><b style=\"color: rgb(237, 35, 8);\">什么是胆总管囊肿？<\/b><\/h1><h1><span style=\"line-height: 1.5;\"> 单纯胆总管囊肿是指胆总管的囊样扩张，先天性胆总管扩张症；是先天性胆管囊肿中最常见的一种类型，具体病因尚不清楚，可能和非正常胚胎发育有关。一般80%的胆总管囊肿在儿童期发病，但近年成人发病者逐渐增加，其中女性占70-80%，亚洲的发病率明显高于欧美。<\/span><\/h1>","watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvMTIxNjcwMTkvYzlmMjZlMGExYmUyNGY3ZjlkMzgzNGZmMTQzMDNjNGNfX2pwZy5oZWlj\/nickname\/5bCP5YS_5aSW56eR546L56OK5Yy755Sf\/userid\/MTIxNjcwMTk=\/sign\/81031fe2c7b776acbfa605b804ff399b"},{"img_height":362,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/12167019\/35af47141ef840a9ad4566cc7c8bcb2a__jpg.heic","img_width":482,"text":"<h1><b style=\"color: rgb(237, 35, 8);\">胆总管囊肿会有什么样的症状？<\/b><br \/>胆总管囊肿多表现为腹痛、黄疸和发热等急性胆管炎的表现，儿童期发病的可以伴有右上腹肿块，严重的还会出现休克和精神症状。晚期出现癌变的可以有消瘦、乏力和贫血等全身消耗症状。<\/h1><h1><b><u style=\"color: rgb(237, 35, 8);\">王磊医生提醒大家，有上述症状一定及时到医院检查就诊，以免错过最佳治疗时间，后悔终生！<\/u><\/b><\/h1>","watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvMTIxNjcwMTkvMzVhZjQ3MTQxZWY4NDBhOWFkNDU2NmNjN2M4YmNiMmFfX2pwZy5oZWlj\/nickname\/5bCP5YS_5aSW56eR546L56OK5Yy755Sf\/userid\/MTIxNjcwMTk=\/sign\/81031fe2c7b776acbfa605b804ff399b"},{"img_height":1200,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/12167019\/816f87cea1324d3398197389b9a620c5__jpg.heic","img_width":1200,"text":"<h1><span style=\"line-height: 1.5;\"><b style=\"color: rgb(237, 35, 8);\">胆总管囊肿如何诊断？<\/b><\/span><\/h1><h1><span style=\"line-height: 1.5;\">大多数胆总管囊肿B超即可初步诊断，超声可以显示胆总管的异常囊样扩张。当然，由于B超的主观性较强，图像的清晰度较差，因此疑似胆总管囊肿的病人我们都会建议复查CT和磁共振，它们对胆总管囊肿的诊断更客观更精确，可以详细了解囊肿的长度、直径、其内有无结石、局部囊壁有无增厚癌变，以及有无同时合并肝内胆管囊肿等。<\/span><\/h1>","watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvMTIxNjcwMTkvODE2Zjg3Y2VhMTMyNGQzMzk4MTk3Mzg5YjlhNjIwYzVfX2pwZy5oZWlj\/nickname\/5bCP5YS_5aSW56eR546L56OK5Yy755Sf\/userid\/MTIxNjcwMTk=\/sign\/81031fe2c7b776acbfa605b804ff399b"},{"img_height":1600,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/12167019\/9ba57c236f704aacadb9f4afa8665b55__jpg.heic","img_width":1200,"text":"<h1><b style=\"color: rgb(237, 35, 8);\">胆总管囊肿如何治疗？<\/b><br \/><span style=\"line-height: 1.5;\">因为学术界一致认为胆总管囊肿是易于和最终几乎都会癌变的，所以一旦确诊胆总管囊肿，不管年龄大小，即应考虑尽快手术。不建议患者做任何形式的观察随访。<\/span><br \/>    如果胆总管囊肿伴发急性胆管炎，可以先在内镜下行鼻胆管或塑料支架内引流，等急性炎症缓解后再行确定性手术。这取代了过去一期手术采用T管外引流的做法。显然，现在的内镜技术比多一次开腹手术创伤大大下降，恢复更快，对病人的影响更小，也减小了第二次确定性手术的难度。<\/h1><h1>    如果是在非急性期发现胆总管囊肿，标准的手术方案应该是胆总管囊肿切除+肝管空肠R-Y吻合术，术后胆汁由原来通过胆总管输送到十二指肠，改道为经空肠襻直接输送到上段空肠。<\/h1>","watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvMTIxNjcwMTkvOWJhNTdjMjM2ZjcwNGFhY2FkYjlmNGFmYTg2NjViNTVfX2pwZy5oZWlj\/nickname\/5bCP5YS_5aSW56eR546L56OK5Yy755Sf\/userid\/MTIxNjcwMTk=\/sign\/81031fe2c7b776acbfa605b804ff399b"},{"img_del":1,"img_height":636,"img_url":"https:\/\/v2-private.ivwen.com\/users\/12167019\/2e12b845989b4e1ab8cbe25ccd3b49b5.jpg","img_width":844,"text":"<h1><b style=\"color: rgb(237, 35, 8);\">什么样的胆总管囊肿适合腹腔镜治疗？<\/b><span style=\"line-height: 1.5;\">　　 <\/span><\/h1><h1><span style=\"line-height: 1.5;\">胆总管囊肿切除+肝管空肠R-Y吻合术过去都是开腹手术，近年已逐渐被腹腔镜微创手术所替代。即使过去有过上腹部开腹手术史的人，目前技术条件都可以考虑腹腔镜微创手术。已有的经验表明，腹腔镜手术的患者创伤小，疼痛轻，恢复快，住院时间短，但由于要使用腹腔镜专用穿刺器和吻合器，可能费用会相对增加。<\/span><\/h1><h3><br \/><\/h3>","sign":{"e":1753297248,"token":"_c-zYrsESvrJbRu6tvNzSlZHm4noQSRy9d0n_oPD:LOUimnjpmzNpPqmWvdfxHQvqnuY=","sign_url":"https:\/\/v2-private.ivwen.com\/users\/12167019\/2e12b845989b4e1ab8cbe25ccd3b49b5.jpg"}},{"img_del":1,"img_height":1202,"img_url":"https:\/\/v2-private.ivwen.com\/users\/12167019\/2d9050c3d50b451fbfa3a6e9825564f3.jpg","img_width":1259,"text":"<h1><b style=\"color: rgb(237, 35, 8);\">哪些人不适合腹腔镜手术？<\/b><\/h1><h1><span style=\"line-height: 1.5;\">总体上目前所有的胆总管囊肿都可以考虑腹腔镜手术，但一些情况下会难度加大，成功率会有所下降，如：上腹部手术史造成上腹部粘连而增加解剖难度，尤其是既往有胆道手术史的；胆总管囊肿急性炎症未消退的；长期反复胆管炎导致胆总管囊肿和周围组织严重粘连分界不清的；既往因胆总管囊肿未行囊肿切除而仅行囊肿空肠内引流术的。<\/span><\/h1>","sign":{"e":1753297248,"token":"_c-zYrsESvrJbRu6tvNzSlZHm4noQSRy9d0n_oPD:VZX7tOMp2lPefHduSCHfIteZNoc=","sign_url":"https:\/\/v2-private.ivwen.com\/users\/12167019\/2d9050c3d50b451fbfa3a6e9825564f3.jpg"}},{"text":"<h1><b style=\"color: rgb(237, 35, 8);\">胆总管囊肿会复发吗？复发后如何治疗？<\/b><br \/>如果胆总管囊肿被完整切除，极少发生囊肿复发。如果胆总管囊肿的胰腺段有残留，可以导致术后囊肿逐渐增大甚至癌变，此时可能需要再次手术才能根治。<\/h1>"},{"img_height":300,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/12167019\/0cf3c33342e14340ae44c3abc0b8244b__jpg.heic","img_width":236,"watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvMTIxNjcwMTkvMGNmM2MzMzM0MmUxNDM0MGFlNDRjM2FiYzBiODI0NGJfX2pwZy5oZWlj\/nickname\/5bCP5YS_5aSW56eR546L56OK5Yy755Sf\/userid\/MTIxNjcwMTk=\/sign\/81031fe2c7b776acbfa605b804ff399b"},{"text":"<h1>\"有时是治愈；常常是帮助；总是去安慰\"。我们一直在前进的道路上努力，努力！<\/h1><h1><span style=\"color: rgb(237, 35, 8);\"><u><b>泰安市妇幼保健院（市儿童医院）外一科团队，祝患儿早日康复！咨询电话：0538-6621702；6626571；15688828296。<\/b><\/u><\/span><\/h1>"}]