先天性胆总管囊肿的手术选择——附46例分析

Analysis of treatment for 46 cases of congenital choledochal cyst

目的探讨合理的先天性胆总管囊肿术式特点与疗效。方法回顾1988年7月￣2003年7月间46例胆总管囊肿分别采用囊肿外引流术5例;囊肿内引流术3例;38例一期囊肿切除胆肠重建术。结果5例囊肿外引流术1￣5个月准备后,完成囊肿切除胆肠通路重建术;2例囊肿内引流术因术后症状反复,分别在6￣8个月后再次手术切除囊肿胆肠重建术;一期囊肿切除术后1例出血再次急诊手术止血,3例偶有腹痛,2例切口感染,1例切口疝。本组无肠瘘、死亡病例。结论胆总管囊肿全切除胆肠重建是根治本病,减少术后并发症最好方法。在囊肿急性炎症期先行囊肿外引流,情况改善后二期囊肿切除胆肠重建术可提高疗效。

To study the characteristics and curative effect of congenital choledochal cyst operation. Among the 46 cases of choledochal cyst treated from July 1988 to July 2003,5 cases were operated on with external drainage of cyst, 3 cases with internal drainage of cyst, and 38 cases with cystectomy (cholecystotomy) and bile duct regeneration. After 1 to 5 months' preparations, 5 cases treated with external drainage of cyst were excised cyst and regenerated bile duct. Of the 3 cases treated with internal drainage of cyst, 2 cases were operated again and were excised cyst because of postoperative symptoms. Of the 38 cases treated with cystectomy (cholecystotomy) and bile duct regeneration, 1 case received emergency treatment to stanch bleeding; 3 cases had bellyache once in a while; 2 cases had infection in incision; and one had incisional hernia. There are no intestinal fistula and death cases. [Conclusion] The congenital choledochal cyst excision and bile duct regeneration is the best method for curing the disease and decreasing postoperative complications. In the period of cyst acute inflammation, external drainage of cyst should be performed first and cyst excision and bile duct regeneration are followed to increase curative effect when the state improves.