腹腔镜下先天性胆总管囊肿切除肝总管空肠Roux-en-Y吻合术

背景Ⅰ型胆总管囊肿的腹腔镜手术治疗由于难度、风险大，少有中心开展。近日我们顺利完成了1例巨大Ⅰ型胆总管囊肿的全腔镜手术治疗。方法采用5孔法，囊肿的显露采用将胆囊与腹壁暂时缝合来完成，用电凝钩顺利完成囊肿的全部分离和切除。肝总管空肠重建方法如下：上提空肠，结肠前距离屈氏韧带25cm处与肝总管行端侧吻合，用4-0的可吸收线连续一层缝合。空肠袢的长度约60cm。结果手术300min，术中出血100ml，未输血。术后5d口服流质饮食，术后7d出院。结论I型胆总管巨大囊肿的全腔镜手术治疗是安全和有效的。

Laparoscopic Complete Cyst Excision and Roux-en-Y hepaticojejunostomy for Choledochal Cyst

Background Laparoscopic complete cyst excision and Roux-en-Y hepaticojejunostomy for choledochal cyst remained a challenging procedure. Recently, a patient with a large choledochal cyst （type I ） received a successful laparoscopic complete cyst excision and Roux-en-Y hepaticojejunostomy in our hospital. Methods By using five-ports method, expose of choledochal cyst was ahieved by temporary suspension of gallbladder onto abdominal wall, while dissection and complete resection of cyst was done. Hepaticojejunostomy was performed in front of the transverse colon, 25 cm distal to the Treitz ligament using 4-0 absorbable sutures, with a jejunal loop of 60 cm. Results The operation time was 300 min with blood loss of 100 ml, without transfusion. The patient started to oral feeding on postoperative day 5 . The postopera- tive hospital stay was 7 days. Conclusion Laparoscopic management of type I choledochal cysts is safe and feasible.