先天性胆总管囊肿62例诊治体会

Experience in the diagnosis and treatment of 62 cases with congenital cyst of common bile duct

目的探讨先天性胆总管囊肿的临床特点,并比较先天性胆总管囊肿不同手术方式的治疗效果。方法对62例先天性胆总管囊肿的手术方式及疗效回顾性进行分析。结果本组62例中,获得随访占42例,随访率为74.2%,随访时间自术后3个月～9年。本组无手术死亡病例发生。手术后并发症是胆漏3例和伤口感染5例。在15例囊肿内引流中,随访7例,疗效优良者3例。囊肿部分切除,残余囊肿空肠吻合术12例,随访11例,疗效优良者7例。囊肿完全切除,肝总管空肠吻合术31例,随访24例,疗效优良者22例。以上3种术式的癌变率分别为28.6%,18.2%和8.3%。结论外引流术适用于危急、重症患者不能耐受其他手术方式时,为第二次手术做准备;囊肿完全切除,胆总管空肠Roux鄄en鄄y吻合术是治疗先天性胆总管囊肿的最佳术式。

Objective To study the Clinical features of congenital choledochocyst,and compare the efficacy of different surgical procedures.Methods From January 1994 to January 2004, 62 cases with congenital choledochocyst in the surgical procedures and efficacy were analyzed retrospectively.Results Among the 62 cases,the follow-up time was from 3 months to 9 years after operation.No operative death was found in this group.Postoperative complication：bile leakage was happened in 3 cases and wound infection 5 cases.In the 15 cases received internal drainage of cyst,7 cases were followed-up and efficacy was excellent and good in 3 cases.In the 12 cases received partial cystectomy and residual cystojejunostomy, 11 cases were followed-up,and efficacy was excellent and good in 7 cases. In the 31 cases received total cystectomy and hepatico jejunostomy, 24 cases were follwed up and efficacy was excellent and good in 22 cases.The canceration rate was 28.6%, 18.2% and 8.3% respectively in the mention above 3 kinds of surgical procedures. Conclusion The external drainage is suitable to patients with critical and severe case.Total cystectomy and hepatico jejunostomy is a best surgical procedure for the treatment of congenital choledochocyst.