囊肿整体切除术治疗小儿先天性巨大胆总管囊肿的临床效果

Holistic resection of cysts for children with huge choledochal cyst

目的 探讨囊肿整体切除术治疗小儿先天性巨大胆总管囊肿的临床效果.方法 选取本院2010年1月至2015年5月收治的29例先天性巨大胆总管囊肿患儿进行研究,均采用胆总管囊肿全切除术与肝总管空肠Roux-en-Y吻合术治疗,观察治疗效果及术后近远期并发症发生情况.结果 29例患儿均顺利完成手术,术中检查发现所有患儿无胰管结石,双侧胆管开口无狭窄发生,但其中14例（44.83％）合并胰胆合流异常.本组患儿术中出血量26.73 ～ 101.82 ml,平均出血量为（53.87±10.54） ml,术后所有患儿均好转并出院.术后共发生3例（10.34％）并发症,包括2例胆漏,1例伤口感染,经对症治疗后均好转,无肠梗阻等严重并发症发生.术后随访9个月～2年,平均（14.15 ± 3.28）个月,所有患儿肝胆功能正常,无营养不良、胰腺病变、胆管结石及反流性胆管炎等并发症发生.结论 囊肿整体切除术治疗小儿先天性巨大胆总管囊肿效果较好,近远期安全性良好.

Objective To investigate the clinical effect of holistic resection of cysts for children with huge choledochal cyst.Methods 29 children with huge choledochal cyst treated at our hospital from January,2010 to May,2015 were chosen for research;all were treated with reconstruction of the extrahepatic biliary system,total resection of common bile duct cyst,and Roux-en-Y choledochojejunostomy.The clinical effect and short-and long-term complications were observed.Results The operation was completed successfully in all the 29 cases.The intra-operative examination found that all children had no pancreatic duct stones and no stenosis in bilateral bile duct opening.However,14 cases （44.83%） complicated with cholangiopancreatoconfluence.The intra-operative bleeding volume was 26.73-101.82 ml,with an average of（53.87±10.54） ml.All the children were cured and discharged from the hospital after the operation.3 cases （10.34%） got postoperative complications,including 2 cases of bile leakage and 1 cases of wound infection;after symptomatic treatment,all of them were improved and no serious complications such as intestinal obstruction occurred.The postoperative follow-up time was 9 months-2 years,with an average of （14.15±3.28） months.All the children had normal liver and gallbladder function,and no malnutrition,pancreatic disease,bile duct stones,and reflux cholangitis occurred.Conclusion Holistic resection of cysts for children with huge choledochal cyst has good treatment effects and good short-and long-term safety.