胆管囊状扩张症：新的临床分型与治疗策略  

Cystic dilation of bile duct： new clinical classification and treatment strategy

作　　者：董家鸿[1] 郑秀海 夏红天[1] 赵向前[1] 梁斌[1] 杨滔[1] 曾建平[1] 黄志强[1] 

机构地区：[1]解放军总医院肝胆外科医院、全军肝胆外科研究所,北京100853 [2]解放军总医院临床医学博士后流动站

出　　处：《中华消化外科杂志》2013年第5期370-377,共8页Chinese Journal of Digestive Surgery

基　　金：国家科技部科技支撑计划项目（2012BAI06801）;中国博士后科研基金（20110491868）

摘　　要：目的 提出胆管囊状扩张症的临床分型及针对不同分型的治疗策略和手术方法。方法 回顾性分析1993年6月至2010年6月解放军总医院收治的434例胆管囊状扩张症患者的临床资料。收集和重新分析患者腹部CT、MRI、MRCP和胆道造影检查结果，根据胆管囊状扩张病变累及胆管树的部位及范围，结合其临床病理特征、发病因素及适用的手术方式提出一种新的胆管囊状扩张症的临床分型；分析新分型中不同胆管囊状扩张症的临床表现、手术方式、围手术期结果、随访结果等资料，针对不同分型胆管囊状扩张症制订治疗策略和手术方法。率的比较采用X2检验，理论频数〈5或总观测频数〈30时，采用Fisher确切概率法。结果 根据囊状扩张病变累及胆管树的部位及病理特征将其分为5种类型：（1）A型：周围肝管型肝内胆管囊状扩张。A1型：囊状扩张病变局限分布于部分肝段；A2型：囊状扩张病变弥漫分布于全肝。（2）B型：中央肝管型肝内胆管囊状扩张。B1型：单侧肝叶中央肝管囊状扩张；B2型：囊状扩张病变同时累及双侧肝叶主肝管及左、右肝管汇合部。（3）C型：肝外胆管型胆管囊状扩张。C1型：囊状扩张病变未累及胰腺段胆管；C2型：囊状扩张病变累及胰腺段胆管。（4）D型：肝内外胆管型胆管囊状扩张。D1型：囊状扩张病变累及单叶中央肝管和肝外胆管；D2型：囊状扩张病变累及双侧肝叶中央肝管和肝外胆管。（5）E型：壶腹胆管型胆管囊状扩张。本组434例胆管囊状扩张症患者中，A型24例（A1型17例、A2型7例），B型13例（B1型10例、B2型3例），C型300例（C1型56例、C2型244例），D型96例（D1型17例、D2型79例），E型1例。24例A型患者中，14例伴有先天性肝纤维化，16例合并多囊肾病，区别于其他各型患者。手术方式：24例A型患者中，17例A1型患者行部分肝切�Objective To suggest a new clinical classification of the cystic dilatation of bile duct （CDBD）, and to design the treatment modality according to different classifications.Methods The clinical data of 434 patients with CDBD who were admitted to the Chinese PLA General Hospital from June 1993 to June 2010 were retrospectively analyzed. The data of computed tomography （CT） and magnetic resonance cholangiopancreatography （MRCP） were collected. A new clinical classification of CDBD was proposed based on the site, pathological features, pathogenic factors of CDBD and relevant surgical procedures.The clinical condition, surgical procedure, treatment efficacy and results of follow up of CDBD patients based on the new classification were analyzed, and then proper surgical treatment method for patients with different types of CDBD was suggested. The data were analyzed using the chisquare test, and Fisher exact probability was applied when the theoretical frequency〈5 or the observed frequency〈30.Results CDBD was classified into 5 types according to the pathological features and the location of cystic dilation in the biliary tree： （1）Type A： cystic dilatation of the peripheral biliary tree was limited to the intrahepatic bile ducts. This type could be subdivided into type A1 （cystic dilation of the bile duct was limited to one hepatic lobe or several segments） and type A2 （cystic dilation of the bile duct was diffused to entire intrahepatic biliary tree）. （2）Type B： cystic dilation of central large intrahepatic bile duct above the hilar convergence. Commonly the disease presented a single localized form limited to one hepatic lobe （type B1）, and cystic dilation in hilar convergence or in bilobar central bile ducts （type B2） was rare. （3）Type C： cystic dilation of the extrahepatic bile duct. According to whether the intrapancreatic bile duct was involved, this type could be divided into type C1 （without intrapancreatic bile duct involvement） and C2 （with

关 键 词：胆管囊状扩张症 分型 治疗 囊状扩张病变切除术 肝切除术 

分 类 号：R657.4[医药卫生—外科学]