先天性胆总管囊肿术后远期并发症及处理

The treatments of long-term postoperative complications of congenital choledochal cyst

目的探讨先天性胆总管囊肿术后远期并发症的治疗。方法回顾分析1999年1月至2008年12月中国医科大学附属盛京医院普外科收治的48例先天性胆总管囊肿术后出现远期并发症的临床资料。结果先天性胆总管囊肿术后远期并发症主要有胆管结石形成31例,反流性胆管炎25例,吻合口狭窄16例,囊肿癌变3例。手术治疗方式包括囊肿彻底切除、肝总管空肠Roux-en-Y吻合术28例,胆肠吻合口切除、再吻合术7例,胆道探查取石术3例,胆道探查取石术并肝段切除术3例,囊肿切除加胰十二指肠切除术1例。经皮经肝胆道镜治疗吻合口狭窄和(或)胆管结石6例。结论先天性胆总管囊肿术后远期并发症的发生常与首次手术方式选择不当有关。治疗上以囊肿切除、去除病灶、解除梗阻、胆胰分流、通畅引流为目标,减少再手术后并发症。

Objective To investigate the experience of treatments of long-term postoperative complication＇s in congenital choledochal cyst （CCC）. Methods Retrospective analysis of the clinical data of postoperative patients with long-term complications in 48 cases of CCC patients from January 1999 to December 2008 in Shengjing hospital of China Medical University. Results The long-term postoperative complications of CCC mainly included 31 cases of biliary lithiasis, 25 cases of repeated cholangitis, 16 cases of stoma stenosis, 3 cases of cyst cancerization. The reoperative methods included complete cyst excision and Roux-en-Y hepatojejunostomy in 28 cases, excision of hepatojejunostomy and reanastomosis in 7 cases, biliary duct exploration and calculus removed in 3 cases, biliary duct exploration and hepatic segment excision in 3 cases, cyst excision and pancreatoduodenectomy in 1 case. 6 cases of stoma stenosis and/or intrahepatic calculus were managed by pereutaneous transhepatie eholangioseopy （PTCS）. Conclusions The long-term postoperative complications of CCC are usually correlated with inappropriate initial operation. In order to prevent the complications of reoperation, the aims for treatment should include cyst excision, calculous focus removing, obstruction disengage, biliopancreatic shunt, and hiliary drainage unobstruction.