先天性胆总管囊肿手术治疗值得注意的几个问题

Several issues in the surgical treatment of congenital biliary dilatation

先天性胆管扩张症是指肝内、外胆管单独或联合的先天性发育异常,多发生于女性,常在婴幼儿期发现。随着医学影像检查在临床应用,少数于成年期发现确诊。先天胆管扩张症多发生于胆总管,并呈梭形扩张,最多见者为I型(先天性胆总管囊肿)。扩张的胆管内胆汁淤滞潴留,可并发胆管炎、结石、穿孔,少数囊壁发生恶变。先天性胆总管囊肿于成年期一经确诊,无论症状轻重,如无手术禁忌证均应手术治疗。目前主张,除非有特殊的适应证,不宜采取内引流或外引流术。彻底切除囊肿,重建肝外胆道是根治先天性胆总管囊肿的标准术式。

Congenital biliary dilatation （CBD） is the disease that the intrahepatic bile duct ：or extrahepatie bile duct has congenital development abnormalities alone or in combination. It mostly occurs in women, often found in early childhood. As the applications of medical imaging in clinical, a few had the diagnosis in adulthood. As occurred in the Common bile duet with spindle-shaped expansion, CBD was called congenital eholedoehal cysts previously. The bile retention in the expansive bile duct may be complicated by eholangitis, stones, perforation and malignancy of cyst Wall. Congenital eholedochal cysts in adulthood without surgical eontraindieations, once diagnosed, regardless of the severity of symptoms, should he taken a surgical treatment. Currently stand, unless there are special indications, it should not be taken internal drainage or external drainage. Complete removal of the cyst and reconstruction of the extrahepatie bile duet is the standard operation to congenital eholedoehal cysts.