完全腹腔镜Roux-en-Y吻合术治疗先天性胆总管囊肿

Total Laparoscopic Roux-en-Y Anastomosis for Congenital Choledochocyst

目的探讨完全腹腔镜下Roux-en-Y吻合术治疗先天性胆总管囊肿的可行性。方法 2011年3～9月,对6例先天性胆总管囊肿行完全腹腔镜下Roux-en-Y吻合术。术中常规切除胆囊,游离囊肿壁,于正常肝总管交界处离断。距十二指肠悬韧带15～20 cm处切断空肠,于断端远端下方约50 cm处用腔镜直线切割吻合器行肠肠吻合,镜下用3-0可吸收线行肝总管-空肠端侧吻合。结果手术均获成功。术后随访3～9个月,平均5.5月,无出血、胆漏、吻合口狭窄、肠漏、腹腔脓肿、逆行感染等并发症发生。结论完全腹腔镜Roux-en-Y吻合术治疗先天性胆总管囊肿是可行的,并且具有切口小、术后腹壁瘢痕小、创伤轻、美观等微创特点。

Objective To explore the feasibility of total laparoscopic Roux-en-Y anastomosis in treating congenital choledochocyst. Methods Total laparoscopic Roux-en-Y anastomosis was performed on 6 patients with congenital choledochocyst from March to September 2011. We resected the gallbladder, isolated the walls of the cyst, and then cut the bile duct at the confluence of the left and right hepatic ducts. Afterwards, the jejunum was cut at 15 -20 cm away from the Treitz＇s ligament so that jejunojejunostomy can be performed with a laparoscopic linear stapler at 50 em away from the stump. Finally, end-to-side anastomosis between the common hepatic duct and jejunum was carried out by using 3-0 absorbable suture. Results The procedure was completed in all the 6 patients without causing biliary leakage, hemorrhage, anastomotic stricture, intestinal leakage, abdominal abscess, retrograde infection or other postoperative complications during a 3- to 9-month follow-up （mean, 5.5 months ）. Conclusions Total laparoscopic Roux-en-Y anastomosis is feasible for congenital choledochocyst with minimal invasion and good cosmetic results.