成人先天性胆管扩张症的诊断与治疗

Diagnosis and treatment of congenital biliary dilatation in adults

目的探讨成人先天性胆管扩张症的诊断与治疗。方法回顾分析我院1985年至2004年30例成人先天性胆管扩张症的临床资料。结果28例行B超检查,确诊率为92.9%(26/28)。5例CT、4例ERCP、3例PTC、6例MRCP检查均全部确诊。本组30例确诊率100%。手术27例,其中囊肿内引流术5例,术后疗效欠佳,囊肿切除肝管空肠Roux-Y吻合术20例,疗效满意。全组无手术死亡。结论上腹痛是成人先天性胆管扩张症最常见的临床表现,结合影像学检查可确诊,囊肿切除肝管空肠Roux-Y吻合术为首选术式。

Objective To investigate the diagnosis and treatment of congenital biliary dilatation in adults. Methods The clinical data of 30 adult patients with congenital biliary dilatation admitted from 1985 to 2004 were analyzed retrospectively. Results Twenty- eight cases underwent B- ultrosonic examination, and the accuracy was 92.9% （26/28）. CT performed in 5 cases, ERCP in 4 cases, PTC in 3 cases and MRCP in 6 cases all confirmed the diagnosis. The definite diagnostic rate in 30 cases was 100 %. Twenty- seven cases underwent surgical therapy. Cystoenterostomy was performed in 5 cases with poor effect, while resection of extrahepatic cyst with Roux- y hepaticojejunostomy was performed in 20 cases with satisfactory curative effect. There was no perioperative mortality. Conclusion Epigastralgia is the most common manifestation. The diagnosis could be confirmed by combining manifestation with imaging feature. Cyst excision with Roux - y hepaticojejunostomy has been generally acknowledged the first choice operation.