儿童及成人先天性胆总管囊肿对比临床分析

Clinical analysis of congenital choledochal cyst in children and adults

目的 研究儿童及成人先天性胆总管囊肿的不同特点 ,提高对先天性胆总管囊肿的诊治水平。方法 回顾分析 3 2例先天性胆总管囊肿的诊治资料 ,将其分为少儿 ( <14岁 )和成人( >14岁 )发病组 ,分析两者不同的临床表现、诊断和治疗特点。结果 少儿组 17例 ,临床表现为持续性黄疸、肝肿大、腹部包块 ,术前一般情况差 ,保守治疗 6例 ,其中 2例因肝硬化腹水 ,肝功能衰竭死亡 ,1例未愈出院 ,3例延期手术 ;手术 14例 ,13例行肝管空肠Roux -Y吻合 ,1例行肝管十二指肠吻合术。成人组 15例 ,以间歇性右上腹疼痛、畏寒发热、黄疸首次就诊 ,分别行囊肿切除肝管空肠吻合术 ( 12例 )、肝管十二指肠吻合术 ( 1例 )、肝左叶并囊肿切除肝管空肠吻合术 ( 2例 )。结论 先天性胆总管囊肿发病患儿起病急 ,病情发展快 ,易合并肝脏损害 ,应加强围手术期支持治疗 ;成人囊肿切除胆道重建术后 ,应密切随访 。

Objective To investigate the different behaviors of congenital choledochal cyst between in children and adults,so as to improve the diagnosis and treatment of congenital choledochal cyst.Methods Thirty patients woith congenital choledochal cyst were divided into child group (<14 years) and adult group (>14 years).Clinical behaviors including manifestation,diagnosis and therapy were analyzed retrospectively.Results Seventeen patients in child group had jaundice,hepatomegly and abdominal mass.In 6 conservatively treated children,2 patients were died from hepatic failure,3 children had delayed operation and 1 child discharged without treatment.In 14 operations,13 received Roux-Y anastomosis of hepatic duct and jejunum,while one were subjected to anastomosis of hepatic duct and duodenum.Manifestations of 15 patients in adult group were pain in right upper quadrant,fever and shivering,jaundice.Cyst incision and anastomosis of hepatic duct and jejunum were done in 12 patients,anastomosis of hepatic duct and duodenum were done in only one patient.Left lobe of liver and cyst were incised and anastomosis of hepatic duct and jejunum were done in 12 patients.Conclusion Children with congenital choledochal cyst were emergency,deteriorated quickly and mostly associated with hepatic dysfunction,so supporting therapy should be enhanced perioperatively.In adults after operation,follow-up should be done to prevent cholangitis and carcinoma of bile duct.