成人先天性胆管扩张症手术治疗39例分析

Surgical treatment of congenital cholangiectasis in adults:a report of 39 cases

目的探讨成人先天性胆管扩张症手术治疗的经验体会。方法1992年10月至2006年2月我院收治的成人先天性胆管扩张症39例患者均行囊肿切除。结果术后短期胆汁漏6例，无胰漏，急性胰腺炎1例，无死亡。39例经1～15年随访，随访率94．6％，2例表现轻度胆管炎，余均痊愈，无胆管炎及胆管狭窄表现。结论囊肿切除、胆管空肠Roux-Y吻合是成人先天性胆管扩张症的首选治疗。切除囊肿时，囊肿近端在尽量切净囊肿的基础上行大口吻合，可吸收线单层吻合，防止术后吻合口狭窄；囊肿远端在保证胰液引流通畅、不损伤胰管开口的基础上，尽量切净囊肿内膜。

Objective To summarize the experience of surgical treatment for congenitally cholangiectasis in adults. Methods Thirty - nine excised cases of adult congenital cholangiectasis admitted between October and February 2006 in our hospital were reviewed. Results Bile leak for a short time occurred in 6 cases. There was no pancreas leak ,no acute pancreastitis and no operative death. All cases were followed up for 1 to 15 years,and the follow - up rate was 94.6%. Two cases had mild cholangitis, and the remaining 37 cases were cured. Conclusion Cyst excision with Roux - Y hepaticojejunost remains the major choice for this disease. Large mouth anastomosis and absorbent lineae and only one anastomosis should be taken in proximate of cyst after resection to prevent stricture of stoma. The tunica inti- ma of cyst should be completely removed on the basis of not injuring debouch of pancreas and ensuring unobstructed drainage of pancreastic fluid.