先天性胆管囊状扩张症的手术治疗

Surgical treatment of congenital cystic dilation of bile duct

目的 探讨先天性胆管囊状扩张症的最佳手术方式。方法 回顾分析我院 1980～2 0 0 2年 76例经手术治疗的先天性胆管囊状扩张症的临床诊疗资料。结果 本组 76例中 ,13例行囊肿空肠Roux en Y吻合术 ;3例行囊肿十二指肠吻合术 ;7例行囊肿外引流术 ;1例行憩室型总胆管囊肿切除T管引流术 ;5 5例行囊肿切除、总肝管空肠Roux en Y吻合术 (占手术病例的 72 4 % ) ;2例Ⅳa型囊肿行肝左外叶切除加总胆管囊肿切除、总肝管空肠Roux en Y吻合术 ,1例Ⅴ型囊肿行肝左外叶切除、总胆管切除、肝门胆管空肠Roux en Y吻合术。 16例囊肿内引流术、7例囊肿外引流术和5 5例囊肿切除总肝管空肠Roux en Y吻合术的术后并发症发生率分别为 5 6 3%、2 8 6 %和 3 6 % ,经统计学分析差异有显著性 (P <0 0 1)。结论 手术是先天性胆管囊状扩张症惟一有效的治疗方法。外引流术可用于全身状态极差而不能耐受较复杂手术的病人 ,待全身状况改善后应及时行二次手术 ;对于较为复杂的Ⅳa型和Ⅴ型病变 ,应选择合适的病例行肝叶切除术或肝移植术 ;总胆管囊肿切除、肝管空肠Roux en Y吻合术是Ⅰ型先天性胆管囊状扩张症的一种较为合理的手术方式。

Objective To investigate the proper operative method for treatment of congenital cystic dilation of the bile duct. Methods The clinical data of 76 patients with the disease treated in our hospital from 1980 to 2002 were retrospectively analyzed. Results All the 76 patients were operated on. The operations were as the follows: (1) Roux-en-Y cystojejunostomy in 13 patients, (2) cystoduodenostomy in 3, (3) external cyst drainage in 7, (4) excision of diverticulum of the common bile duct and T-tube drainage in 1, (5) excision of the bile duct and Roux-en-Y hepaticojejunostomy in 55. Two cases of type Ⅳa received hepatolobectomy and excision of the bile duct cyst and Roux-en-Y hepatocojejunostomy. One case of type Ⅴ received hepatolobectomy and excision of the bile duct and Roux-en-Y hepaticojejunostomy. The occurring rate of postoperative complications was 47.8% in 23 patients receiving internal and external drainage but only 3.6% in those receiving excision of the bile duct cyst and Roux-en-Y hepaticojejunostomy. There was significant difference between the two groups of patients ( P <0.01). Conclusions Resection of cyst and biliary tract reconstruction is the optimal choice for treatment of the congenital cystic dilation of the bile duct. External drainage can be used for the severe cases with a complication of congenital cystic dilation of the bile duct. For the proper cases of type Ⅳa and type Ⅴ, hepatolobectomy or liver transplantation can be used. Excision of the bile duct cyst and Roux-en-Y hepaticojejunostomy is of the first choice for treatment of the disease of type I.