儿童胆总管囊肿合并Ⅳ型副肝管的诊治体会

Diagnosis and treatment experience of choledochal cyst in children with type Ⅳ accessory hepatic duct and literature review

目的:探讨儿童胆总管囊肿合并Ⅳ型副肝管的诊断与治疗策略。方法:回顾分析2012年12月至2020年6月收治的5例胆总管囊肿合并Ⅳ型副肝管患儿的临床资料,其中女4例,男1例,5个月至10岁,术前均常规行彩超、腹部CT及MRCP检查,1例于术中行副肝管造影。结果:术前MRCP确诊胆总管囊肿合并Ⅳ型副肝管1例,怀疑合并Ⅳ型副肝管并于术中证实1例,余3例中2例于术中发现,1例于术中误损伤,并经术中胆道造影确诊。患儿均在腹腔镜下行肝总管、副肝管分别与空肠胆肠吻合。手术时间300(285,310)min,术中出血量18(15,25)mL。术后恢复顺利,无胆漏等并发症发生,术后7(7,9)d出院。术后随访3个月至5年,相关实验室指标未见异常,无肝萎缩、肝硬化发生。结论:儿童胆总管囊肿合并Ⅳ型副肝管临床较少见,一旦疏忽其存在或处理不当可能导致胆漏、肝萎缩、肝脓肿、肝硬化等严重并发症。MRCP对此类疾病的诊断存在一定困难。腹腔镜下肝总管、副肝管分别与空肠行胆肠吻合术是较好的治疗选择。

Objective:To explore the diagnosis and treatment strategy of choledochal cyst in children with typeⅣaccessory hepatic duct(AHD).Methods:A retrospective analysis was performed on the clinical data of 5 children who suffered from choledochal cysts and typeⅣAHD from Dec.2012 to Jun.2020.Among them,4 cases were female and 1 case was male,aged from 5 months to 10 years.All children underwent color Doppler ultrasound,abdominal CT and magnetic resonance cholangiopancreatography(MRCP)before surgery,and 1 child underwent auxiliary cholangiography during operation.Results:One case of choledochal cyst combined with typeⅣAHD was diagnosed by MRCP before surgery.1 child was suspected to have typeⅣAHD by MRCP,and was confirmed during operation.Of the remaining 3 patients,2 were found during the anatomy in the surgery,and 1 case was found by intraoperative injury and was confirmed by intraoperative cholangiography.All children underwent laparoscopic anastomosis of AHD and common hepatic duct with jejunum.The operative time was 300(285,310)min,and intraoperative blood loss was 18(15,25)mL.The postoperative recovery of these children was smooth without biliary leakage.These children were discharged 7(7,9)d after surgery.A follow-up lasting for 3 months to 5 years showed no abnormal blood tests,neither hepatatrophia nor cirrhosis occurred.Conclusions:Children's choledochal cyst with typeⅣAHD is rare in clinical practice.However,once this disease is neglected or mishandled,it is easy to induce serious complications such as biliary leakage,hepatatrophia,hepatic abscess and cirrhosis.It is difficult for MRCP to diagnose this disease.Laparoscopic anastomosis of AHD and common hepatic duct with jejunum is a better treatment strategy.