新生儿期胆总管囊肿术后乳糜腹一例报告并文献复习

One case of congenital laparoscopic choledochal cyst with postoperative chylousascites and a retrospective literature review

目的 报道1例新生儿期腹腔镜胆总管囊肿术后并发乳糜腹,并通过文献回顾和复习,提高临床上对此类罕见病的认识.方法 1例14 d的男患儿,因"产前超声示肝门部包块4个月伴生后持续黄疸"入院,入院后肝功能检查示:丙氨酸转氨酶(ALT)110 U/L、天冬氨酸转氨酶(AST)180 U/L、总胆红素(TBIL)310.9μmol/L、直接胆红素(DBIL)183.0μmol/L.术前B型超声及M RC P术中造影检查均提示胆总管囊肿.入院后完善术前检查行腹腔镜下胆总管囊肿切除、肝总管空肠Roux-Y吻合术.通过检索PubMed、Medline、Springer Link、The Cochrane Library及中国知网、万方等数据库,检索关键词:乳糜腹(chylous ascites),胆总管囊肿(choledochal cyst),新生儿(neo-natal).检索截止日期为2018年10月,中英文共报道胆总管囊肿术后并发乳糜腹4例.结果 我院这例乳糜腹水患儿经过禁食、静脉营养及生长抑素等保守治疗后在术后3周乳糜腹水消失,随访半年,生长发育良好无复发.通过文献检索的4例胆总管囊肿术后并发乳糜腹的患儿,治疗均以禁食、静脉外营养支持及生长抑素保守治疗,1例因乳糜引流量少(20 ml)仅行饮食治疗,乳糜引流量最多达350 ml,治疗时间15 d至4周,病例均康复出院.结论 腹腔镜下胆总管囊肿术后并发乳糜腹临床少见,但只要治疗得当,预后良好.

Objective To report one case of congenital laparoscopic choledochal cyst with postoperative chylous ascites and review the relevant literatures of this disease for enhancing its clinician awareness .Methods One 14-day boy was hospitalized due to 4-month prenatal ultrasonic finding of hilar mass of liver with persistent jaundice .After admission , liver function examination showed that alanine aminotransferase 110 U/L ,aspartate aminotransferase 180 U/L ,total bilirubin 310 .9 μmol/L and direct bilirubin 183 .0 μmol/L .Preoperative ultrasonography ,magnetic resonance cholangiopancreatography (MRCP) and intraoperative angiography revealed choledochal cyst .After preoperative examinations ,laparoscopic choledochal cyst resection and Roux-Y hepaticojejunostomy were performed .The databases of PubMed ,Medline ,Springer Link ,Cochrane Library ,CNKD and Wanfang were searched for such keywords as chylous ascites ,choledochal cyst and neonatal .Four cases of choledochal cyst complicated with chylous ascites were reported in both Chinese and English up until October 2018 .Results Chylous ascites became resolved after 3-week conservative treatments of fasting , total parenteral nutrition and octreotide .During a 6-month follow-up period , he grew healthily without a relapse .Four cases of choledochal cyst complicated with postoperative chylous ascites were reviewed in the literature .All of them were treated conservatively .One child received only dietary treatment due to a low amount of celiac drainage (20 ml) .The maximal celiac drainage was 350 ml and treatment duration lasted from 15 days to 4 weeks .All children recovered and were discharged .Conclusions Congenital laparoscopic choledochal cyst with postoperative chylous ascites isa rare disease .However ,its prognosis is excellent if it is diagnosed timely and treated properly .