57例成人先天性胆管囊肿的诊治分析

Diagnosis and treatment of 57 cases of congenital biliary duct cyst

目的总结先天性胆管囊肿的诊治经验方法对2015年~2019年共收治的57例先天性胆管囊肿患者的临床资料进行回顾性分析。结果成人胆总管囊肿症状多不典型,常见临床表现为腹痛、黄疸、发热,腹部包块少见。4例合并癌变,癌变率为7.0%,上皮内瘤变19例,瘤变率33.33%。57例患者中,53例行B型超声检查,45例行腹部CT检查,49例行MRCP检查,3例行ERCP诊治,2例行PTCD诊治,诊断以B超、CT及MRCP为主,均确诊。手术方式有:囊肿切除+肝管空肠Roux-en-Y吻合术,胆肠吻合口拆除重建,胆总管十二指肠吻合口拆除+胆总管囊肿切除+肝总管空肠内引流,肝叶切除+囊肿切除+肝总管空肠内引流术,囊肿切除+根治性胰十二指肠切除术等。囊肿切除+肝管空肠Roux-en-Y吻合术是主要手术方式。术后并发症主要有胆管炎、胆瘘、腹腔感染、肠梗阻、胰瘘、消化道出血、囊肿癌变。全组无手术死亡。结论对Ⅰ、Ⅳb型先天性胆管囊肿采用囊肿全切除,肝管空肠Roux-en-Y吻合术,胰腺段胆管应可能切除。对于Ⅳa型先天性胆总管囊肿,如果肝叶切除能解决肝内扩张胆管或肝内胆管狭窄,则考虑联合肝叶切除。

Objective To summarize the experience in diagnosis and treatment of congenital biliary duct cyst. Methods Clinical data from 57 patients treated from 2015 to 2019 were analyzed retrospectively. Results Clinical symptoms in adult patients were non-specific, including abdominal pain, jaundice and fever, abdominal mass was rarely seen. Carcinoma of the biliary duct occurred in 4 patients(6.9%). Intraepithelial neoplasia of the biliary duct occurred in 19 patients(33.33%).Ultrasonic examination was perofrmed in 53 patients, CT in 45,and 49 in MRCP, ERCP in 3, and PTCD in 2. the diagnosis was decided with ultrasonography, CT and MRCP. All of the patients were correctly diagnosed before operation. The procedure included cyst excision with Roux-en-Y hepaticojejunostomy, excision of hepatojejunostomy and reanastomosis, excision of choledochoduodenostomy and cyst excision with Roux-en-Y hepaticojejunostomy, hepatectomy and cyst excision with Roux-en-Y hepaticojejunostomy, cyst excision and pancreaticoduodenectomy. The main procedure was cyst excision with Roux-en-Y hepaticojejunostomy. The postoperative complications mainly included cholangitis, biliary fistula, abdominal infection, intestinal obstruction, pancreatic fistula, hemorrhage of digestive tract, cyst cancerization. None of the patients died after operation. Conclusions Cyst excision with Roux-en-Y hepaticojejunostomy is strongly recommended as the treatment of choice for patients with typeⅠand Ⅳb cysts. The pancreatic bile duct be resected just above the pancreatic duct junction, leaving as little as possible. For patients with type Ⅳa cysts, if hepatectomy solves the problem of cystic dilatation or stenosis of the intrahepatic bile duct, the procedure may be considered.