成人先天性胆管扩张症与胰腺炎发作的关系  

The relationship of congenital choledochus cyst(CCC)with occurence of pancreatitis in adults

作　　者：雷春[1] 陈炯[1] 邵成颂[1] 虞德才[1] 汤志刚[1] 李文波[1] 杜敏[1] 孙振阳[1] 

机构地区：[1]安徽医科大学附属省立医院普通外科,安徽合肥230001

出　　处：《中国普通外科杂志》2007年第5期415-417,共3页China Journal of General Surgery

摘　　要：目的探讨先天性胆管扩张症(CCC)与胰腺炎发作的关系及其外科治疗方法。方法回顾性分析1997年6月—2005年12月期间收治的17例CCC患者的临床资料。17例患者术前均经B超和磁共振胰胆管造影(MRCP)检查明确诊断,其中4例行腹部CT检查,术中造影检查6例,2例行内镜下胰胆管造影(ERCP)。结果先天性胆管扩张症Ⅰ型10例,Ⅱ型4例,Ⅲ型1例,Ⅳ型1例,Ⅴ型1例;其中14例合并胆囊、胆管结石(11例为泥沙样色素结石,3例为胆固醇结石),5例合并慢性胆囊炎,1例合并胆囊息肉,10例合并胰胆管合流异常(APBJ),10例(58.8%)合并胰腺炎发作。行胆总管囊肿切除和胆肠内引流手术治疗14例,行保留幽门胰十二指肠切除术1例,行胆囊切除术加T管引流术2例。术后随访中14例无胰腺炎发作,2例仍有胰腺炎发作,1例意外死亡。结论合并有APBJ和泥沙样结石的CCC患者容易发生急性胰腺炎,对CCC合并APBJ患者行胆总管囊肿切除、胆囊切除术和胆道Roux-en-Y内引流术可减少胰腺炎发作。Objective To discuss the relationship of congenital choledochus cyst （ CCC ） with occurrence of pancreatitis in adults and methods of surgical treatment. Methods The clinical data of 17 adult patients with congenital choledochus cyst who underwent surgical treatment from 1997 - 2005 were analyzed retrospectively. Results Clinical diagnosis was made mainly by B-ultrasound, MRCP, intraoperative cholangiography, ERCP and CT scans. Among 17 cases, 10 cases were congenital choledochus cyst type Ⅰ , 4 cases type Ⅱ , 1 case type m , 1 case type Ⅳ and 1 case type Ⅴ; and associated with cholelithiasis in 14 cases （bile pigment stone in 11 cases, cholesterol calculus 3cases ）, chronic cholecytitis 5 cases, polypoid lesions of gallbladder 1 case, anomalous pancreaticobiliary junction （ APBJ ） 10 cases, and pancreatitis 10 cases. Resection of extrahepatic cyst with Roux-y hepaticojejunostimy was performed in 15 cases, preserving pylorus pancreatoduodinectomy in 1 case, and cholecystectomy and T tube drainage in 1 case. Excellent and good results were achieved on follow-up in 14 out of the 17 CCC cases undergoing surgical treatment, while pancreatitis occurred in 2 cases and unexpected death in 1 case. Conclusions Pancreatitis is apt to occurr in CCC with APBJ and bile pigment stone in choledochus. The incidence of pancreatitis in CCC and APBJ （P-B） can be decreased by resection of extrahepatic cyst and Roux-en-Y hepaticojejunostimy and cholecystectomy.

关 键 词：先天性胆管扩张症/外科学 胰腺炎 胰胆管合流异常 

分 类 号：R657.4[医药卫生—外科学]