胆管囊肿的外科诊疗现状及焦点问题

Surgical management of choledochal cyst:status quo and hot issues

胆管囊肿是儿童及成人胆道外科的常见棘手难题。尽管近年来外科诊疗技术已有显著进步,但与疾病相关的概念、诊断和分型等基本问题仍有不足之处,脉管解剖变异、肝内胆管狭窄等相关病变的处理仍是术中的认知盲区,关于胰腺段胆管囊肿的处理、肝内扩张胆管的切除范围等问题仍存在一定争议。在腹腔镜或机器人辅助技术治疗胆管囊肿的病例逐渐增多的同时,再手术的病例亦渐有增多趋势,提示了需关注胆管囊肿患者术后长期疗效的重要性。本文结合临床实践及研究证据,对胆管囊肿的外科治疗现状及焦点问题进行系统梳理和探讨,以期进一步提高胆管囊肿的诊疗水平。

Choledochal cyst is one of the most common congenital diseases in the biliary tract system,which can affect both children and adults.While surgical management has changed markedly in recent years,researchers′understanding related to the nomenclature,diagnosis and classification of choledochal cysts remains inadequate.Anatomical variations and stricture of the intrahepatic bile duct are prone to be overlooked during surgery.Furthermore,it is still controversial in the treatment of intrapancreatic choledochal cyst and the extent of resection related to dilated bile ducts.Along with the advancement of laparoscopic or robotic-assisted procedures,there is also an increase in reoperations for patients with choledochal cyst,which underscores the importance of long-term biliary patency.This state-of-the-art review on choledochal cyst aims to further improve the diagnosis and treatment of this benign but intractable disease.