先天性胆总管囊肿诊治探讨

THE DIAGNOSIS AND TREATMENT OF CONGENITAL CHOLEDOCHAL CYST

目的:探讨先天性胆总管囊肿的临床特点,选择合适的手术治疗方式。方法:对46例先天性胆总管囊肿的临床资料进行回顾性分析。结果:46例病人中,41例行囊肿切除、肝管空肠鲁氏Y形吻合,2例因严重粘连出血而行囊肿空肠吻合,2例囊肿巨大,伴有严重感染者先期行外引流术,待一般情况好转后二次行根治性手术。1例因重症胆管炎行外引流。结论:对囊肿伴严重感染者先期行外引流术可有效控制感染。囊肿全切除、肝管空肠鲁氏Y形吻合应作为胆总管囊肿的首选术式。完整的囊肿切除、胆肠吻合口应尽可能地大,保证胆肠黏膜对黏膜的完整吻合。

Objective： To evaluate the clinical features of and appropriate surgical modality for congenital choledochal cyst. Methods： Retrospective study on the clinical data of 46 surgically treated congenital choledochal cyst cases was made. Results： Among the 46 cases, surgical correction was applied to 41 cases with cyst excision and Roux- en- Y hepaticojejunostomy as the main procedure. Cystjejunostomy was adopted in 2 cases with severe adhesion and bleeding. External drainage of the congenital choledochal cyst was adopted first in 2 cases to tide the patient over serious infection, before second stage definite radical resection was carried out. Other 1 patient with severe cholangitis underwent single external drainage of the congenital choledochal cyst. Conclusion： External drainage is mandatory for congenital choledochal cyst patients with severe infection. The total choledochal cyst excision, with Roux- en- Y hepaticojejunostomy is effective in the treatment of congenital choledochal cyst. Total excision of choledochal cyst, extension of normal hepatic ducts anastomoses opening and mucous membrane to mucous membrane anastomoses played key roles in the succeed operation.