先天性胆管囊肿再手术原因分析及防治

Analysis and prevention of reoperation on congenital choledochal cyst

目的探讨先天性胆管囊肿再手术的原因及防治。方法对１８年中２２例再手术患者的性别、年龄、囊肿类型、手术时机和术式进行回顾性分析。结果再手术率２４４％（２２／９０）；患者性别、年龄和囊肿类型与再手术率无显著关系（Ｐ均＞００５）；再手术率与手术时机、术式选择和手术操作等因素有关；急诊手术再手术率显著高于择期手术者（Ｐ＜００１）；再手术率以囊肿外引流术最高（８８９％），囊肿内引流术次之（５２４％），囊肿切除术最低（５０％），三组间差异有极显著意义（Ｐ均＜００１）。结论胆管囊肿一经确诊，应尽早手术，以免被迫行急诊手术；经皮肝胆管造影术（ＰＴＣ）和内窥镜逆行胰胆管造影术（ＥＲＣＰ）应慎用；囊肿外引流术只能作为急救措施；囊肿内引流术应废用；囊肿切除、肝总管空肠ＲｏｕｘＹ吻合术应作为首选术式。

Objective To invastigate the reasons and prevention of reoperation on congenital choledochal cyst (CCC).5HZMethods The sex, age, cyst type, timing and method of operation were analyzed 22 reoperated (CCC) patients who underwent reoperation. Results The reoperation rate was 244% (22/90).The gender age and cyst type werent related to reoperation rate (P>005). Reoperation rate was corelated with the timing the modality and the manoeuvre of the surgery. The previous emergent surgery incurred higher reoperation rate than that of selective operation(P<001). The reoperation cate was 88.9% in patients previously undergoing CCC extracorporeal drainage, it was 52.4% in group of internal drainage and 5.0% in group previously undergoing CCC resection(P<001). Conclusions Congenital choledochal cyst should be treated by surgery in its early stage.Pradent policy should be adopted on the use of PTC and ERCP. Outer drainage was used as the firstaid measure; internal drainage should be abandoned; resection of the cyst with RouxY hepaticojejunostomy should be the therapy of choice.