切除困难的成人先天性胆管扩张症术中对策

Intraoperative strategies for difficult surgical excision of adult congenital biliary dilatation

成人先天性胆管扩张症一般情况下需要切除囊性扩张的胆管和病变的肝脏,去除结石,并行胆肠吻合术。但因病情复杂,表现多样及疾病的进展,可出现伴随肝脏、胆道、胰腺甚至门静脉系统的病变,例如肝内外胆管结石、胆管癌、胰腺炎、门静脉高压症等,而且部分病人可能经历过多次手术治疗,这些因素的共同影响将使得部分成人先天性胆管扩张症的外科治疗面临困难与挑战。在切除困难的成人先天性胆管扩张症中,需要依据病人的病变特点,制定个体化的手术措施,既能最大范围切除病灶,亦能最大限度保存正常组织,避免发生术后严重并发症。

The general treatments for adult congenital biliary dilatation （CBD） usually include resection of cystic dilated bile ducts and liver lesions, removing of bile stones, and cholangioenterostomy. However, some patients may have complex history and manifestations. With the progress of the disease, many complicated changes of the liver, biliary system, pancreas and portal vein system, such as calculus of bile duct, carcinoma of bile duct, pancreatitis and portal hypertension may occur. Besides, part of patients might have the experience of several times of surgery. The above factors confront surgical treatment of the disease with a lot of difficulties and challenges. For difficult surgical excision situations, individuated surgical procedures should be undertaken according to the characteristic of each patient. In general, it should maximize the excision of lesions and preservation of normal tissues and avoid serious postoperative complications.