先天性胆总管囊肿14例报告

Congenital Choledochal Cysts.A Report of 14 Cases

本文报告14例先天性胆总管囊肿的诊断,除有腹痛、右上腹包块和黄疸三联征外,超声检查右上腹有囊性肿物,钡餐透视胃和12指肠向左移,即可考虑本病。80％发生于女性,90％小于20岁。误诊原因是缺乏对本病的认识。诊断一经成立,均应手术治疗。术中先行囊肿穿刺,证实诊断后酌情选择术式。文中强调内引流术后,胆囊失去正常功能应一并切除。为预防吻合口瘘,采用了肠腔和肝下引流。为防止食物逆流和感染,采用遮断术或间置空肠、顺蠕动人工空肠套叠、胆(或肝)总管12指肠吻合术,能防止溃疡病发生,有其优越性。

Fourteen cases (12 females, 2 males) of congenital choledochal cysts are reported. Their age ranged from 4.5 months to 45 years. The classical triad which comprises right upper quadrant abdominal mass, jaundice and pain occurred in a majority of the cases. Ultrasonic study was done in 13 cases and in all cystic mass was noted in the right upper quadrant of abdomen. Displacement of the duodenum and stomach was found in radiographic studies in 4 patients. Once the diagnosis was established, surgical intervention was performed without delay. During the surgical operation paracentesis of the cyst was done as the first step for diagnosis. The authors stress that after internal drainage, the gallbladder by and large was removed on account of loss of function. Institution of intestinal and subhepatic drainages were important in preventing the hazard of leakage. The authors also recommend jejunal interposition, artificial invagination and choledochocystoduo- denostomy from technic point of view as measures to prevent ascending infection, reflux and ulcer formation.