Comparative analysis of different hepaticojejunostomy techniques for treating adult type I choledochal cyst  

不同胆管空肠吻合技术治疗成人Ⅰ型胆总管囊肿的比较分析

作　　者：Wenjie Ma Yongqiong Tan Anuj Shrestha Fuyu Li Rongxing Zhou Junke Wang Haijie Hu Qin Yang 

机构地区：[1]Department of Biliary Surgery,West China Hospital of Sichuan University,Chengdu,China [2]Operation Room,West China Hospital of Sichuan University,Chengdu,China [3]Department of General Surgery,Andaki Medical College,Pokhara,Nepal

出　　处：《Gastroenterology Report》2018年第1期54-60,I0002,共8页胃肠病学报道（英文）

基　　金：supported by grants from the Science&Technology Support Project of Sichuan Province(No.2014SZ0002–10 and No.2015FZ0076).

摘　　要：Objective:To compare Roux-en-Y hepatico-jejunostomy with complete resection of the cyst or incomplete resection with 1-cm remnant proximal cyst wall in treating adult type I choledochal cyst(CC).Methods:The medical records of 267 adult patients with type I CC from January 1998 to December 2015 were reviewed retrospectively.Among them,171 underwent Roux-en-Y hepatico-jejunostomy with complete resection(PBD 0-cm group)and 96 underwent Roux-en-Y hepatico-jejunostomy with 1-cm proximal cyst wall left(PBD 1-cm group).The short-and long-termpost-operative complications were compared between the two groups.Results:No significant difference was observed in operative time or anastomotic diameter between the two groups.The incidence of perioperative complications was significantly higher in the PBD 1-cm group than that in the PBD 0-cm group(28.1%vs 14.0%,p¼0.005),especially post-operative cholangitis(7.3%vs 1.2%,p¼0.021).The incidence of long-term post-operative complications was not significantly different,including anastomotic stricture,reflux cholangitis,intra-hepatic bile duct stones and bile leak(all p>0.05).Post-operative intra-pancreatic biliary malignancy occurred in one patient in the PBD 0-cm group at 25 months and one patient in the PBD 1-cm group at 5 month,respectively.Anatomical site malignancy was observed in one patient in the PBD 1-cm group at 10 months.Conclusion:Ease of performing anastomosis does not justify retaining a segment of choledochal cyst in type I CC due to its higher risk of post-operative complication and malignancy.A complete excision of the CC with anastomosis to the healthy proximal bile duct is necessary in treatment of type I CC.目的:比较囊肿完全切除与不完全切除(残留近端1 cm胆总管囊壁)的Roux-en-Y胆管空肠吻合治疗成人Ⅰ型胆总管囊肿的安全性和可行性。方法:回顾性分析1998年1月至2015年12月间收治的267例成人Ⅰ型胆总管囊肿患者的病例资料,其中171例行囊肿完全切除的Rouxen-Y胆管空肠吻合术(PBD 0-cm组),96例行囊肿不完全切除的Rouxen-Y胆管空肠吻合术(PBD 1-cm组)。比较两组患者术后短期及长期并发症发生情况。结果:两组患者在手术时间和吻合口直径方面的差异均无统计学意义。PBD 1-cm组围手术期并发症发生率显著高于PBD 0-cm组(28.1%vs 14.0%,P=0.005),尤其是术后胆管炎(7.3%vs 1.2%,P=0.021)。两组患者术后吻合口狭窄、反流性胆管炎、肝内胆管结石和胆漏等长期并发症的差异均无统计学意义(均P>0.05)。PBD 1-cm组和PBD 0-cm组各有1例患者分别于术后5月和术后25月出现胰胆管恶变。而PBD 1-cm组有1例患者于术后10月出现吻合口恶变。结论:虽然保留部分囊壁可以降低Ⅰ型胆总管囊肿切除术中的吻合难度,但由于相对较高的术后并发症发生率和恶变概率,该吻合方式值得商榷。对于Ⅰ型胆总管囊肿患者,囊肿完全切除后以健康的近端胆管进行吻合是必要的。

关 键 词：Choledochal cyst roux-en-Y hepatico-jejunostomy biliary drainage ADULTS 

分 类 号：R65[医药卫生—外科学]