目的：探讨和总结完全腹腔镜下胆肠Roux-en-Y 吻合术的手术技巧及技术改进。方法：回顾性分析2011 年10 月—2014 年10 月期间行改良完全腹腔镜下胆肠Roux-en-Y 吻合术的25 例患者临床资料。其中先天性胆总管囊肿（I 型）10 例，胆总管结石合并下段炎性狭窄2 例，胰头癌6 例，胆总管下端癌5 例，壶腹周围癌2 例。结果：全组患者均成功完成手术，无中转开腹。先天性胆总管囊肿手术时间（194.5±20）min，炎性狭窄及恶性肿瘤导致梗阻性黄疸手术时间（120±23.5）min；胆管空肠吻合时间为（18.4±3.3）min，空肠空肠吻合时间为（17.4±2.3）min；平均术中出血（38.8±35.8）mL，下床活动时间（2.0±0.9）d，排气时间（2.48±0.7）d，术后住院时间（7.96±1.9）d。术后1 例发生少量胆汁漏，经延长腹腔引流时间痊愈。24 例（96.0%）获得随访1~36 个月，1 例患者术后出现反流性胆管炎，经抗感染等治疗后痊愈；所有患者均未出现黄疸复发。结论：完全腹腔镜下胆肠Roux-en-Y 吻合术是安全、有效、可行的，通过技术改进，能降低手术难度，简化手术流程，缩短手术时间。
Application of modified totally laparoscopic Roux-en-Y hepaticojejunostomy: a report of 25 cases
Objective: To investigate and discuss the surgical practice and technical improvement of totally laparoscopic Roux-en-Y hepaticojejunostomy. Methods: The clinical data of 25 patients undergoing modified totally laparoscopic Roux-en-Y hepaticojejunostomy between October 2011 and October 2014 were retrospectively analyzed. Of the patients, 10 cases were congenital choledochal cysts (type I), 2 cases were common bile duct stone with distal inflammatory stricture, 6 cases were cancer in the head of the pancreas, 5 cases were distal bile duct cancer, and 2 cases were periampullary cancer. Results: Operation was successfully completed in all patients, with no need for open conversion. The operative time for choledochal cysts was (194.5±20) min and for obstructive jaundice caused by inflammatory stricture or tumors was (120±23.5) min; the time for hepaticojejunal anastomosis was (18.4±3.3) min and for jejunojejunal anastomosis was (17.4±2.3) min; the intraoperative blood loss was (38.8±35.8) mL, time to ambulation was (2.0±0.9) d and to first flatus was (2.48±0.7) d, and the length of postoperative hospital stay was (7.96±1.9) d, respectively. Minor bile leakage occurred in one patient after operation, which ceased after prolonged drainage. Follow-up was obtained in 24 patients (96%) for 1-36 months, postoperative reflux cholangitis occurred in one patient, which was resolved by anti-infective treatment, and no relapse of jaundice was noted in any of the cases. Conclusion: Totally laparoscopic Roux-en-Y hepaticojejunostomy is safe, effective, and feasible, and technical improvement can reduce the surgical difficulty, simplify the surgical procedure and shorten the operative time.