囊肿切除、胆道重建治疗先天性胆总管囊肿  

Biliary reconstruction after excision of choledochal cyst in childen

作　　者：李昭铸[1] 陶文芳[1] 韩福友[1] 王凤兰[1] 管声扬[1] 孙岩[1] 张旗涛[1] 

机构地区：[1]哈尔滨医科大学附属第二医院小儿外科,150086

出　　处：《中华小儿外科杂志》2001年第3期168-171,共4页Chinese Journal of Pediatric Surgery

基　　金：.NULL

摘　　要：目的　总结 2 4年囊肿切除、胆道重建手术治疗先天性胆总管囊肿的经验 ,探讨有关的治疗问题。方法　回顾 1975～ 1999年 12 4例囊肿切除胆道重建手术治疗的先天性胆总管囊肿患者 ,其中行囊肿切除、肝总管空肠Roux y吻合 97例 (加曾氏防反流瓣 87例 ) ;囊肿切除、间置空肠十二指肠吻合 14例 (加人工套叠瓣 4例 ) ;囊肿切除、肝总管十二指肠吻合 8例 ;囊肿大部切除、胆道重建5例。对手术方式、手术后近、远期并发症进行分析。结果　 12 4例中Ⅰ型 118例 (囊性扩张 10 2例、梭形扩张 16例 ) ,Ⅱ型 2例 ,Ⅳ 4例。近期并发症有 :术后出血 5例 ,胆汁漏 7例 ,胆系感染 2例 ,吻合口梗阻 1例 ,肠梗阻 4例 ;无围手术期死亡。远期并发症 :反流性胆管炎 2 6例 ,胆系结石 5例 ,胆管癌3例 ,肠梗阻 6例。结论　囊肿切除胆道重建术是治疗先天性胆总管囊肿的最佳方法 ,提高手术技巧 。Objective To discuss the experiences of hepaticoenterostomy after excision of choledochal cyst by investigating the who result of the surgery in 124 cases of congenital choledochal cyst (CCC). Methods 122 children with CCC received the operation between 1975 and 1999 were reviewed. Hepaticojejunostomy with Roux en Y in 97 cases, hepaticoduodenostomy in 8 cases and 14 cases with interposed segment of jejunum after excision of the cyst. Partial excision of choledochal cyst were performed in 5 cases. The operation methods and complications were discussed.Results Of 124 cases with CCC, type Ⅰ accounted for 118 cases, type Ⅱ 2 cases, type Ⅳ 4 cases. There was no dead and complications of bleeding were found in 5 cases, anastomic leakage in 7 cases, cholangitis in 2 cases, anastomotic obstruction in 1 case, intistinal obstruction in 4 cases during hospital stay. Late complication consisted of 26 cases recurrent cholangitis, 5 cases stone formation in bile duct, 3 cases biliary carcinoma, 6 cases intistinal obstruction.Conclusions Excision of choledochal cyst and hepaticoenterostomy is the best method for treatment of CCC in children. Important operative skills and prevent of cholangitis in of great importance for the improvement of quality of life.

关 键 词：胆总管囊肿 胆管炎 癌 儿童 先天性胆道重建 

分 类 号：R726.5[医药卫生—儿科]