成人先天性胆总管囊肿外科治疗体会  

Surgical treatment of adult congenital common bile duct cyst

作　　者：李留峥 徐雷升 俸家伟 向春明 彭联芳 王志萍 张洪波 于杰 

机构地区：[1]云南省临沧市人民医院肝胆外科,云南临沧677000

出　　处：《肝胆胰外科杂志》2015年第5期361-364,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：云南省中青年学科带头人后备人才培养基金资助(2006PY01-63)

摘　　要：目的探讨成人先天性胆总管囊肿的外科治疗方法。方法回顾性分析2000年1月至2015年1月收治的21例成人先天性胆总管囊肿资料,对其诊断和治疗方法进行总结。结果全组术前均行B超和CT检查,行MRI检查9例,行ERCP检查3例。术前诊断先天性胆总管囊肿16例,急性胆管炎2例,胆总管结石2例,急性坏疽性胆囊炎1例。全组均手术治疗,囊肿外引流术3例;囊肿空肠Roux-Y吻合术3例;囊肿切除＋肝总管空肠Roux-Y吻合术15例,其中同时肝左外侧叶切除1例。术后病理诊断均为胆总管囊性扩张,其中伴癌变1例。术后因多器官功能衰竭死亡1例,术中切断肝动脉1例,胆漏1例,胸腔积液1例。16例获随访,随防时间2个月~8年。术后因肝内多发转移死亡1例;症状消失10例;症状未缓解5例,为外引流术后2例和内引流术后3例,3个月至3年内再次行囊肿切除、肝总管空肠Roux-Y吻合术4例,拒绝再次手术1例。结论成人先天性胆总管囊肿无特征性症状,B超检查简便实用,MRCP对诊断有重要价值。囊肿切除、肝总管空肠Roux-Y吻合术疗效确切。Objective To discuss the surgical treatment of adult congenital congenital choledochocyst.Methods The data of 21 cases of congenital choledochocyst were retrospectively analyzed from Jan. 2000 to Jan. 2015, and the diagnosis and treatment methods were summarized. Results All groups were performed with CT. Nine cases were examed with MRI and 3 cases were examined with ERCP. Sixteen cases of congenital choledochal cyst, 2 cases of acute cholangitis, 2 cases of common bile duct stones, 1 case of acute gangrenous cholecystitis were diagnoset before operation. One cases were treated with surgery, 3 cases were performed with cyst external drainage, and 3 cases with cyst jejunum Roux-Y anastomosis. Cyst excision and hepatic duct jejunum Roux-Y anastomosis were performed in 15 cases, in whom 1 cases underwent left lateral lobe resection. The pathological diagnosis of cases of bile duct cystic dilatation, including 1 case with carcinoma of the bile duct at the same time. Death due to multiple organ failure in 1 cases of death, surgery to cut off the hepatic artery in 1 cases, 1 cases of bile leakage, 1 cases of pleural effusion.16 cases were followed up for 2 months to 8 years. After the surgery, multiple liver metastasis and 1 cases died; the symptoms disappeared in 10 cases; Symptoms did not ease in 5 cases, 2 cases of external drainage and postoperative drainage, 3 eases, 3 months to 3 years, 4 cases of cyst resection, hepatic duct jejunum Roux-Y anastomosis, 1 cases refused to re operation. Conclusion There is no characteristic symptom of adult congenital common bile duct cyst, and the ultrasonic examination is simple and practical, and MRCP has important value in diagnosis. The curative effect of cyst resection and hepatic duct jejunum Roux-Y anastomosis.

关 键 词：先天性胆总管囊肿 外科治疗 

分 类 号：R657.4[医药卫生—外科学]