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目的对腹腔镜下行巨大先天性胆总管囊肿切除肝管空肠Roux-Y吻合术进行探讨。方法对7例巨大胆总管囊肿(直径11～21cm)行囊肿切除+肝管空肠Roux-Y吻合术。术中行囊肿穿刺减压,切除胆囊,然后从扩张囊肿的中部横断囊肿前壁吸出胆汁,将囊肿壁全层分7～8块逐渐彻底切除。结果7例患儿均顺利完成巨大胆总管囊肿切除+肝管空肠Roux-Y吻合术,无中转开腹手术者。手术时间5.5h～7.6h,平均6.3h;出血量5ml～15ml;6例患儿切除远端囊肿时未找到与胰管相通的管道,仅1例见到明确的远端狭窄的肝管予以结扎。术后无切口感染、胆漏、胰漏和肠梗阻发生,均3d拔除腹腔引流管。术后住院时间4d～6d。随访3个月～19个月,无胆管炎和结石发生,肝功能检查指标均在正常范围内。结论腹腔镜下巨大先天性胆总管囊肿切除、肝管空肠Roux-Y吻合术是一种安全可靠的手术方法。
Objective To investigate the technique of Roux-Y anastomosis of laparoscopic resection of giant choledochal cyst in patients with giant congenital choledochal cyst. Methods 7 cases of giant choledochal cyst (diameter 11 ~ 21cm) cyst excision + Roux-Y hepaticojejunostomy. Surgical cyst puncture decompression, removal of the gallbladder, and then from the middle of the expansion of the cyst transversal cyst anterior wall suction bile, the full-thickness cyst wall 7 to 8 gradually removed. Results All the 7 patients successfully completed the procedure of giant choledochal cyst excision + Roux-Y hepaticojejunostomy without conversion to laparotomy. Surgery time 5.5h ~ 7.6h, an average of 6.3h; bleeding volume 5ml ~ 15ml; 6 cases of children with distal cysts removed did not find the same duct connected to the duct, only 1 case to see a clear distal stenosis of the liver to ligation. Postoperative incision infection, bile leakage, pancreatic leakage and intestinal obstruction occurred, were removed 3d abdominal drainage tube. Postoperative hospital stay 4d ~ 6d. Followed up for 3 months to 19 months, no cholangitis and stones, liver function tests were within the normal range. Conclusion Laparoscopic resection of giant congenital choledochal cyst and Roux-Y hepaticojejunostomy is a safe and reliable surgical method.