囊肿切除胆道重建治疗胆总管囊肿20年经验

EXCISION OF CHOLEDOCHAL CYST AND RE-ESTABLISHMENT OF BILEPASSAGE FOR CONGENITAL CHOLEDOCHAL CYST

目的 探讨改进胆总管囊肿切除的疗效及预防胆道重建术后并发症。方法 总结 1981～ 2 0 0 0年 4 9例胆总管囊肿施行切除及胆道重建术的疗效 ,其中 1994年前的 2 2例保留囊肿后壁一期囊肿次全切除 ,胆总管近端或肝总管远端保留少许囊壁与肠管吻合 ;近年 2 7例行囊肿全部切除 ( 4例外引流后二期切除 ) ,扩大正常肝管与肠管吻合 ,吻合口≥ 3 .0 cm。结果 囊肿次全切除组手术死亡 2例 ,胆瘘 2例 ,切口感染 2例。随访 17例 ,4例常有腹痛、发热。近年囊肿全切组术后平稳 ,仅切口感染 2例。2 1例随诊 3个月～ 5年 ,仅 1例偶有腹痛、发热。结论 胆总管囊肿全切除 ,扩大正常肝管吻合口可预防吻合口狭窄及复发性胆管炎等并发症 ;对全身情况差者先行胆囊或囊肿外引流 ,情况改善后二期囊肿切除可提高疗效。

Objective To evaluate the curative effect of improved excision of choledochal cyst and prevent postoperative complications of re-establishment of the bilepassage. Methods Excision of choledochal cyst and re-establishment of the bilepassage were performed in 49 patients. Before 1994, 22 cases underwent primary subtotal excision of posterointernal wall of choledochal cyst with hepaticoenterostomy. In recent years,27 cases underwent total excision of choledochal cyst,(4 with secondary cyst excision), extending normal re-establishment of bilepassage. The anastomotic opening was wide and large(≥3.0 cm).Results Two patients died in surgery. Two had anastomotic leakage and two were infected after subtotal excision of choledochal cyst in the former years.17 patients were followed up, among whom 4 patients had frequent epigastralgia and fever. No death occurred in postoperative 27 patients with total excision in recent years. Only one of the 21 patients expe- rienced abdominal pain and fever through 3 months to 5 years follow-up. Conclusion Total excision of choledochal cyst and extension of normal hepatic ducts opening may prevent anastomotic stricture and recurrent cholangitis. For those patients with poor health, extra-cholecystic drainage and secondary excision should be performed to improve the effect of treatment.