先天性胆管囊肿诊治经验(附80例报告)  

Diagnosis and treatment of congenital choledochal cyst (A report of 80 cases)

作　　者：王伟[1] 耿小平[1] 朱立新[1] 熊奇如[1] 朱化刚[1] 

机构地区：[1]安徽医科大学第一附属医院普外科,安徽合肥230022

出　　处：《外科理论与实践》2008年第4期352-354,共3页Journal of Surgery Concepts & Practice

基　　金：安徽省教育厅自然科学重点项目资助(kj2008A155)

摘　　要：目的:探讨先天性胆管囊肿的诊断及治疗方法。方法:回顾分析我院7年来80例先天性胆管囊肿的临床资料。结果:诊断方法包括腹部超声、CT、MRCP及ERCP,术前误诊1例。80例中合并癌变者10例,癌变率为12.5%。与良性病变相比,恶性肿瘤组病例与男性、高龄、黄疸、高胆红素水平及引流手术史等因素相关(P<0.05)。行胆总管囊肿切除加肝管空肠Roux-en-Y吻合术72例;囊肿外引流术2例;胰十二指肠切除术2例;囊肿并肝叶切除加肝管空肠Roux-en-Y吻合5例。80例均治愈出院。随访8个月～7年,良性病变组无严重长期并发症;10例合并恶性病变中8例于术后数月内死亡,2例生存至今。结论:先天性胆管囊肿合并恶性肿瘤者预后较差。肝功能差、有过引流手术史的老龄男性,应高度怀疑恶变的可能。术前确诊多有赖于影像学方法。一经确诊,应尽早手术治疗。首选术式为囊肿切除加肝管空肠Roux-en-Y吻合术。Objective To discuss the diagnosis and treatment of congenital choledochal cyst （CCC）. Methods The clinical data from 80 CCC patients admitted during the past 7 years were retrospectively analyzed. Results Imaging techniques, such as abdominal ultrasonography, CT, MRCP and EPCP, were the principal mains of diagnosis. One patient was misdiagnosed before surgery. Malignancies were noted in 10 patients （12.5%）. Patients developing malignant lesions were closely related with the following factors： male gender, advanced age, jaundice, hyper-bilirubinemia, and history of previous biliary drainage. Cyst excision with hepato-jejunal Roux-en-Y anastomosis were performed in 71 cases; external drainage of CCC in 2 cases; Whipple＇s procedure in 2 cases; cyst excision and hepatectomy with hepato-jejunal Roux-en- Y anastomosis in 5 cases. All patients were discharged. The duration of followed-up ranged from 8 months to 7 years. No severe long-term complications were observed in patients with benign lesions. Eight of the 10 patients with malignancy died in a few months after operation, the other two are still surviving. Conclusions The prognosis of CCC patients with malignancy remains poor. Malignancy should be suspected in male, aged patients, especially in those with impaired liver function and history of previous drainage procedure. The correct preoperative diagnosis of CCC depends mainly on the application of imaging techniques. Once diagnosed, surgical intervention should be timely considered. Cyst excision with hepato-jejunal Roux-en-Y anastomosis is the optimal procedure.

关 键 词：胆总管囊肿 诊断 外科手术 

分 类 号：R657.44[医药卫生—外科学]