先天性胆总管囊肿的诊断与治疗体会

Diagnosis and Treatment of Congenital Choledochal Cyst

目的探讨先天性胆总管囊肿的诊断和治疗方法.方法回顾性分析临沧市人民医院2005年1月至2014年12月收治的36例先天性胆总管囊肿的临床资料.对诊断和手术方法进行总结分析.结果全部病例均行B超和CT检查,其中19例行MRCP检查,6例行ERCP确诊.36例均行手术治疗,其中3例行急诊囊肿外引流术,择期行囊肿切除、肝总管空肠Roux-y吻合术27例,囊肿空肠Roux-y吻合术6例.出现并发症6例(13.9%),其中术后多器官功能衰竭死亡1例,术中肝动脉切断1例,切口裂开1例,胆漏2例,胸腔积液1例.术后31例获随访,20例症状消失,7例因急诊囊肿外引流术或囊肿内引流术,症状未缓解再次行囊肿切除、肝总管空肠Roux-y吻合术.2例胆管炎偶尔发作,消炎治疗症状消失.2例左肝管多发结石行肝左外侧叶切除术,痊愈.结论 B超是诊断先天性胆总管囊肿的首选方法,囊肿切除、肝管空肠Roux-y吻合术是治疗先天性胆总管囊肿可选择的术式.

Objective To explore the diagnosis and treatment of congenital choledochal cyst.Methods Theclinical data of36cases of congenital choledochal cyst treated in our hospital from2005to2014were retrospectivelyanalyzed.The diagnosis and surgical methods were analyzed.Results All the patients underwent B and CTexamination,19cases underwent MRCP scan,6cases diagnosed by ERCP.36cases underwent surgical treatment,including3cases of emergency external cyst drainage,resection,underwent cyst and Roux-y hepaticojejunostomyin27case-s,6cases of cyst jejunum Roux-y anastomosis.Complications occurred in6cases(13.9%),with1patients died of mult-iple organ failure,1case of hepatic arteries were cut off,1case of incision dehiscence,2cases of bile leakage,1case of pleural effusion.31cases were followed up,20pati-ents symptoms disappeared,7cases of cyst drainage due to the emergency room or internal drainage of cyst,without relieving symptoms underwentcyst resection,hepatic duct jejunum Roux-y anastomosis.2cases of occasional bouts of cholangitis,anti-inflammatory treatment the symptoms dis-appeared.2cases of left hepatic duct lithiasis underwent left laterallobectomy of liver,cure.Conclusion B ultrasound is the first choice for the diagnosis of congenital common bileduct cyst,cyst resection and hepatic duct jejunum Roux-y anastomosis is an effective surgical procedure for thetreatment of congenital cyst of common bile duct.