婴儿胆道扩张症伴胆道发育不良的手术治疗  

Surgical treatment for infant biliary hypoplasia with huge choledochal cyst

作　　者：罗喜荣[1] 詹江华[1] 胡晓丽[1] 宫济春[1] 

机构地区：[1]天津儿童医院普外科,300074

出　　处：《中华普通外科杂志》2013年第8期582-585,共4页Chinese Journal of General Surgery

摘　　要：目的探讨巨大胆总管囊肿伴胆道发育不良症患儿的诊断和手术难点。方法回顾性分析胆道扩张症患儿278例，其中3例伴有肝外巨大囊肿的胆道发育不良症患儿。本组患儿术中都进行胆道造影检查，了解肝内、外胆管通畅情况以及肝内胆管扩张情况；术中行肝脏活检，行囊肿切除术，术中放置肝总管支架管，并行肝总管-空肠Roux-en-Y吻合手术。结果3例患儿手术年龄在1～2个月之间，术中造影显示囊肿较巨大，左、右肝管发育较细且与肝内相通，有黄色胆汁流出。切开囊肿时有1例损伤肝总管，行肝总管修补手术，并行肝总管部位囊肿成型术，再行肝门一空肠吻合术。3例患儿术后无吻合口狭窄和结石形成；肝活检病理证实有通畅胆管，但胆管数量减少，未见类似胆道闭锁的胆管增生以及胆栓形成。术后随访1～5年，未见黄疸发生，超声显示无肝内胆管扩张。结论术中胆道造影检查非常必要，如遇囊肿巨大，左、右肝管较细，切开囊肿时应小心，切口位置选择在胆囊管水平以下，勿损伤肝管，造成吻合困难，吻合时放置支架管对于早期胆汁引流意义重大。Objective To explore diagnosis and treatment of biliary hypoplasia with hugecholedochal cyst in infants. Methods From Feb 2003 to Dec 2011, 278 choledochal cyst cases were treated in our hospital. There were 3 infant cases of biliary hypoplasia with huge extrahepatic choledochal cyst diagnosed and treated during this period. All patients underwent cholangiogram demonstrating patent, but markedly diminutive extrahepatic biliary structures. After excision of the cyst, hepatic duct was injured in 1 case. The cyst wall was removed, a stent was put inside of hepatic duct, and Roux-en-Y hepatico- jejunostomy was porformed. Results All three patients （ages from 1 month to two months） received the Roux-en-Y hcpaticojejunostomy, none of our patients has developed stenosis and fistula of the Roux-en-Y hepaticojejunostomy. Intraoperative cholangiogram showed the huge choledochal cyst and diminutive intrahepatic ducts. All three cases were followed-up for 1 -5 years, there was no jaundice and nor stones formation. Conclusions In cases of huge choledochal cyst when intraoperative cholangiogram demonstrates a diminutive biliary tree with huge choledochal cyst, great care is required during cyst excision in order not to injury the hepatic duct. Stent placement into hepatic duct helps bile flow at early stage after surgery.

关 键 词：胆总管囊肿 外科手术 胆道发育不良 胆道扩张症 

分 类 号：R726.5[医药卫生—儿科]