23例先天性胆管囊性扩张症的诊疗分析

Analysis on diagnosis and therapy of congenital cystic dilatation of bile duct in 23 cases

目的总结先天性胆管囊性扩张症的临床诊疗经验。方法回顾性分析该院1997年3月至2008年3月诊治的23例先天性胆管囊性扩张症病例的诊疗过程及随访结果。结果大部分患者临床表现不典型,具有典型的腹痛、黄疸和腹部包块三联征者仅占4.35%;B超诊断率为78.26%,CT、磁共振胰胆管造影(MRCP)和经内镜逆行胆胰管造影(ERCP)诊断率均为100%;手术以囊肿切除加胆道重建为主,全组无手术重大并发症病例,随访4个月至3年,无术后癌变病例。结论先天性胆管囊性扩张症诊断依靠影像学资料,B超可用于筛查,术前检查推荐MRCP,ERCP不作首选;治疗依靠外科手术,手术方式以囊肿切除加胆道重建为基本原则。

Objective To summarize the diagnosis and treatment experience of congenital cystic dilatation of the bile duct.Methods The clinical data of 23 patients with congenital cystic dilatation of the bile duct were analyzed retrospectively.Results The clinical manifestations of most cases were atypical and the cases with the typical triad（abdominal pain,jaundice and abdominal lump） were only 4.35%.The detection rate of B type ultrasonography was 78.26%,while that of CT,MRCP and ERCP was 100%.The main treatment was cyst resection plus bile duct reconstruction.No severe complications and postoperative canceration cases were found in these patients.Conclusion The diagnosis of congenital cystic dilatation of the bile duct depends on the imaging data.B type ultrasonography could be used for screening.MRCP is recommended for preoperative detection.ERCP is not recommended for first choice.Cyst resection plus bile duct reconstruction may be recommended as the basic principle of operation.