成人型胆管囊肿的诊治分析

Diagnosis of Bile Duct Cysts in Adults

目的:探讨成人型胆管囊肿的临床特点和治疗方法。方法:收集1994年12月-2004年12月上海复旦大学附属华山医院普外科收治的成人胆管囊肿15例,所有病例均经B超、胆道造影检查确诊并按Todani’s分型,随后行囊肿切除+胆管空肠Roux-en-Y吻合(1例因急性胆道出血而未行该术式)。结果:所有手术患者无一例死亡,病理证实为胆管囊肿13例,1例为胆管囊腺瘤,1例未取病理。随访期8年,无复发、残余囊肿无癌变。结论:ERCP、MRCP对于成人型胆管囊肿的诊断,尤其是临床分型具有重要的作用,而ERCP更能为某些有严重并发症的患者创造手术条件。囊肿切除+胆管空肠Roux-en-Y吻合仍为标准术式。

Objective：To discuss the clinical manifestations and treatment of bile duct cysts （BDCs） in adults. Methods：Fifteen adult patients with BDCs were treated between December, 1994 and December, 2004 in Shanghai were analyzed. All patients were diagnosed by ultrasound, ERCP, and MRCP. The grading of patients was based on Todani＇s classification. Extrahepatic cyst excision with a Roux-en-Y hepaticojejunostomy was performed in 14 patients. Results：The overall operative mortality rate was 0%. According to the results of pathological biopsy, 13 patients were diagnosed as BDC and 1 patient was diagnosed as bile duct cystadenoma. During a follow-up of 8 years, all patients remained free of reoccurrence and development of cancer. Conclusion：ERCP and MRCP are crucial for the diagnosis of BDCs in adults, especially the grading. Furthermore, ERCP helps to prepare patients with severe complications for the surgery. Extrabepatic cyst excision with a Roux-en-Y bepaticojejunostomy is still the best way of surgery.