成人先天性胆总管囊肿83例诊治分析

Analysis of diagnosis and treatment of 83 adult patients with congenital choledochal cysts

目的：探讨成人先天性胆总管囊肿的诊治。方法：分析2001年1月至2010年8月，我院83例成人先天性胆总管囊肿患者临床资料。结果：腹痛是其主要的临床表现（86.75%），其次为黄疸（56.63%）和发热（42.17%）。B超、CT和MRCP的诊断率分别为85.54%，92.86%和94.67%。83例患者中，72例接受手术治疗，术后随访51例（70.83%），中位随访时间38月（3月~100月）。患者术后恢复良好。5例随访的行胆管癌根治术患者中位生存时间为21月，4例行姑息手术治疗的患者中位生存时间为6月。结论：成人先天性胆总管囊肿的诊治应重视临床表现，MRCP有助于诊治。一旦确诊应早期手术治疗，以防癌变。囊肿切除和肝总管空肠Roux-en-Y吻合术应作为首选术式。

Objective： To investigate the diagnosis and treatment of congenital choledochal cysts （CCC） in adults. Methods： Clinical data of 83 patients with CCC in our hospital from January 2001 to August 2010 were retrospectively reviewed. Results： Abdominal pain was the chief symptom occurring in 86.75% patients and next were of jaundice and fever, occurring in 56.63% and 42.17% patients respectively. In diagnosing CCC, the sensitivity of B ultrasound, CT and MRCP was 85.54%, 92.86% and 94.67% respectively. Among 83 patients, 72 underwent surgical treatment, 51 （70.83%） were followed-up. The median follow-up time was 38 months （3 to 100 months）. Patients had good recovery after operation. The median survival time for five followed-up patients who underwent cholangiocarcinoma radical operation was 21 months,the other 4 patients who underwent palliative surgical treatment was 6 months. Conclusions： Clinical manifestation is important in diagnosing adult CCC. MRCP which has no mortality is the choice to help the diagnosis of CCC. In order to avoid biliary malignancy, surgical treatment should be done as soon as possible. Cyst resection and Roux-en-Y hepatojejunostomy should be the preferred surgical procedures.