Objective To explore the safety and efficacy of total laparoscopic choledochal cyst excision in adult by modified techniques.Methods A total of 10 cases treated by totally laparoscopic choledochal cyst excision and biliojejunal Roux-en-Y anastomosis from October 2013 to October 2016 were retrospectively analyzed.The cyst and gallbladder were completely resected with ultrasound knife under laparoscope by using sharp and blunt dissection.The hepaticojejunostomy was conducted by using "single point method" full thickness continuous suture.A side-to-side anastomosis of jejunum was carried out with Endo-GIA.Results All the cases were successfully implemented of laparoscopic resection, without conversion to open surgery.The operation time was 150-310 min (mean, 184.3 min).The operative time of single point hepaticojejunostomy was 18-45 min (mean, 22.7 min).The volume of intraoperative blood loss was 30-120 ml (mean, 50.5 ml).The pain score at post-operative day 1 was 1-4 points (mean, 2.0 points).The patients passed flatus in 1-3 d (mean, 2.0 d).The average hospital stay time after operation was 5-11 d (mean, 6.0 d).Biliary leakage occurred in 1 patient, which recovered after drainage.All the patients were followed up for 2-36 months (mean, 17.2 months).Jejunum anastomositis due to greasy food occurred in 1 patient, which recovered after anti-infection.Conclusion Total laparoscopic choledochal cyst excision using sharp and blunt dissection and a modified technique of single point hepaticojejunostomy is safe and effective, and the degree of hepaticojejunostomic difficulty is reduced.%目的 探讨改进的腹腔镜下解剖分离技术以及胆肠吻合技术在完全腹腔镜胆总管囊肿切除术中的应用价值.方法 2013年10月~2016年10月,对10例成人先天性胆总管囊肿行完全腹腔镜下胆总管囊肿切除、胆囊切除、肝管空肠Roux-en-Y吻合.腹腔镜下超声刀锐性分离结合吸引器冲洗钝性解剖法游离并完整切除胆总管囊肿和胆囊,用"一点法"全程全层连续缝合技术行肝管空肠端侧吻合,用腔镜下直线切割吻合器行空肠侧侧吻合. 结果 全组均成功完成腹腔镜手术,无中转开腹.手术时间150~310 min,平均184.3 min,其中"一点法"肝管空肠吻合时间18~45 min,平均22.7 min.术中出血量30~120 ml,平均50.5 ml.术后第1天疼痛评分1~4分,平均2.0分,肛门排气时间1~3 d,平均2.0 d,术后住院时间5~11 d,平均6.0 d.1例术后少量胆漏,余无围手术期并发症.10例均获得随访,随访时间2~36个月,平均17.2月,1例术后21天因饮食因素导致空肠吻合口炎,保守治愈,无反流性胆管炎、吻合口狭窄等. 结论 完全腹腔镜下应用超声刀锐性分离结合吸引器冲洗钝性解剖法切除成人先天性胆总管囊肿是安全、有效的."一点法"全程全层连续胆肠吻合技术能够简化操作及降低腹腔镜下缝合难度,有助于腔镜术式的开展.
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