胆管囊肿的诊治分析(附41例报告)

The diagnosis and management of biliary cyst

目的 :探讨胆管囊肿的诊断及治疗方法。方法 :回顾性分析 4 1例先天性胆管囊肿的临床资料。结果 :临床表现为腹痛 32例 (78.0 % ) ,黄疸 18例 (43.9% ) ,腹部包块 14例 (34 1% ) ,发热、寒颤 6例 (14 .6 % ) ,出现胆管囊肿三联征 6例 (14 .6 % ) ;30例行B超检查 ,2 6例见胆管扩张 ;18例行CT检查、15例发现胆管扩张 ;10例行MR检查 ,9例有胆管扩扩长。 37例患者施行手术治疗。 2 7例行胆管空肠吻合 (2 3例行Roux -en -Y吻合 ) ,3例行单纯胆管十二指肠吻合 ,3例行外引流术 ,2例行肝叶(段 )部分切除 ,2例行单纯囊肿切除、胆管重建。结论 :伴腹痛、肿块、黄疽 ,胆管囊肿三联征者不多见。Ⅰ型在临床上多见 ,B超、CT和MR有重要诊断价值 ,能代替有创检查如PTC或ERCP。目前最佳手术方法为囊肿切除、胆管空肠吻合术。

Objective: To evaluate the diagnostic and therapeutic methods for biliary cysts.Methods: the medical records of 41 patients were reviewed. Results: Of 41 patients, 78% of the patients presented with an abdominal pain.43.9% with jaundice,34. 1% with an abdominal mass,and 14.6% with a fever .Classic triad was only found in 6 patients. the accurate rates of ultrasonography, CT and MRI were 86.7%, 83.3%, and 90% respectively. of 37 patients who under went operative interventions,cystojejunostomy was employed in 27 patients(23 witlh a Roux-y type of anastomosis).cystoduodenostomy 3, extermal drainage 3,segmental resection of liver 2,cyst resection and bile duct plasty 2. Conclusion: Majority of the patients with choledochal cysts presented an abdominal pain and classic triad was seldom found. Type 1 cyst was the dominant type of the cyst.Ultrasonography,CT and MRI are of high value in dvaluation ot biliary cyst and could replace the conventional examinations of PTC and ERCP.Cyst excision with Roux-en-Ycystojejunostomy was the best choice of surgical management for the cyst patients