先天性胆总管囊肿76例疗效观察

Therapeutic Observation on 76 Cases of Congenital Choledochal Cyst

目的:探讨先天性胆总管囊肿的诊治与疗效。方法:本组76例,分别采用囊肿切除肝总管空肠Roux-Y吻合加矩形瓣防返流术38例;囊肿切除短段空肠代胆道术38例。术后进行3个月-5年的随访,得出优、良、差三种不同结果。结果:治愈出院74例,死亡2例。随访62例,占84％。囊肿切除肝总管空肠Roux-Y吻合加矩形瓣防返流术随访30例:优11例,良13例,差6例,优良率占80％。囊肿切除短段空肠代胆道加矩形瓣防返流术随访32例:优18例,良14例,优良率100％。结论:囊肿切除肝总管空肠Roux-Y吻合加矩形瓣防返流术术后并发症多,包括吻合口狭窄,逆行感染,复发性胆管炎等,疗效不理想;囊肿切除短段空肠代胆道术虽手术操作复杂,但主要优点是恢复了胆汁的生理通道,手术恢复后疗效相当满意。

Objective: To study the treatment for congenital choledochal cyst and its curative effects. Meethods; Of the 76 cases,38 were operated on with cystecto my and Roux- en - Y hepaticojejunostomy plus antireflux rectangle valvoplasty(Roux - en - Y HJ) ,38 with hepticojejunod uodenostomy(HJD). Postoperative follow - ups from 3 to 5 months were conducted. Results : Seventy - four cases were cured. Two cases died. Sixty - two( 84%) cases were foUowed up. Thitry cases in Roux - en -T HJ group were followed up with the following results; 11 were excellent, 13 good,6 poor,and the excellent and good rate was 80 percent.In the HJD group,32 cases were followed up: 18 excellent, 14 good,and the excellent and good rate was 100 percent . Conclusions: With Roux - en - Y HJ there are more postoperative complications, including anastomotic stricture, retrograde infection, recurrent cholangitis, anceration, ect. Its curate effect is unsatisfactory. Though its operating procedure is complex, HJD has the advantage of resuming the physiological outflow tract of bile, and its curative effect is quitd satisfactory.