成人先天性胆管囊肿的诊断与治疗(附97例报告)

Diagnosis and treatment of congenital choledochal cysts in adults

作者总结了近３０年来成人先天性胆管囊肿９７例的治疗经验。患者平均就诊年龄为３７岁。多数患者症状不典型，常致诊断延误。７４例（７６％）合并肝胆胰系统疾病，１６例合并癌变，癌变率１７％。发现胰胆管合流异常２８例。９４例患者共行胆道手术１６９例次，囊肿切除、肝管空肠Ｒｏｕｘ－Ｙ吻合术及囊肿内引流术为主要术式。术后长期随访表明内引流术后常因胆管炎复发和囊肿癌变而需再次手术，相反囊肿切除术明显降低了胆管炎的复发率及癌变的发生。作者认为囊肿切除、肝管空肠Ｒｏｕｘ－Ｙ吻合术应作为成人胆管囊肿的首选术式。

We report the experience with 97 adult patients with bile duct cysts in the past 30 years (1965～1995).The median age at time of initial therapy in our department was 37 years (range,16 to 78 years).Clinical symptoms in most cases were non specific ,resulting in delayed diagnosis.74 patients (76%) had coexistent pancreaticohepatobiliary disease.Carcinoma of the biliary duct occurred in 16 patients (17%).Abnormal pancreatobiliary duct junction (APBDJ) was found in 28 patients.94 patients underwent a total of 169 biliarytract procedures.Cyst excision with Roux en y hepaticojejunostomy and internal drainage were the main procedures.The result of long term follow up shows that internal drainage frequently resulted in recurrent cholangitis and cyst malignancy which need reoperation.In contrast,cyst excision was associated with a significantly lower incidence of recurred cholangitis and lower occurrence of malignancy.Thus,cyst excision with Roux en y hepaticojejunostomy is recommended as the treatment of choice for adult patient.