The Use Of Laparoscopy In The Treatment Of Adult Type ? Congential Choledochal Cysts

Object:To explore the feasibility and curative effect of laparoscopic treatment for type-1congential choledochal cysts in adults.Information:We retrospectively analyzed 9 cases of type-1 cognential choledochal cysts adult patients,who were applied laparoscopic choledochal cyst excision plus Roux-en-Y hepaticojejunostomy in Fujian Provincial Hospital between April 2014 to August2015. Among them,there were 1 male and 8 females, aged 18-58 years, with an average of 33.5 years. Tthere were 6 patients suffered chronic abdominal pain,1patient suffered acute abodomial pain associate with jaundice, 1 patient suffered acute abodomial pain associate with ferver and 1 case was found by physical examination. All patients were preoperatively diagnosed type-1 choledochal cysts by B ultrasound and computed tomography(CT) scan or magnetic resonance imaging(MRI) scan. The transverse diameter of them were 3-8 centimeters,the average diameter was 6 centimeters. Among them, 4 patients sociated with gallbladder stones or common bile duct calculi. The ones who suffered with cholangitis decided to surgery after the controlling of actue inflammation. The 9cases of patients with preoperative inspection had not obvious operative taboo.Methods:All the patients applied excision plus Roux-en-Y hepaticojejunostomy.6 of them applied completely laparoscopic Roux-en-Y hepaticojejunostomy,3 of them applied Roux-en-Y hepaticojejunostomy and then expanded the main operating hole to accomplish the anastomose of Intestinal bowel end side.Results :All cases were successfully operated, No one case transferred. The averageoperation time was 300±17min, the average intraoperative blood loss was about100±20ml. The postoperative anal exhaust time was 2.35±0.68 days and 2.35±0.75 days start eating liquid. No perioperative deaths. One patient arised pancreatic fistula with abdominal cavity infection complications after three days of postoperation and heal by ultrasound guided celiac catheter drainage. The rest of the patients postoperativel recovered well, no complications. The postoperative hospitalization days was 6-22 days, and the average hospitalization days was10.41±3.51 days. 9 cases verify of congenital bile duct expansi after the postoperative pathological diagnosis, no cases suffered cancer. The last follow-up time is January 20, 2016, after an average follow-up of 8 ~ 20 months, no case of readmission patients applied cyst recurrence, cancer and anastomotic stenosis.Conclusion :Nowaday, the laparoscopic technique is becoming more and more proficiency,choosing the right cases and appling the laparoscopic treatment to adult patients with congenital bile duct cysts type I have less bleeding, small wound and fast recovery such as advantage. It is curative effectivily, safety and effectivily. It will be expected to be as a routine method for the treatment of type I congenital choledochal cysts adult patients in the further.