Objective:To compare Roux-en-Y hepatico-jejunostomy with complete resection of the cyst or incomplete resection with 1-cm remnant proximal cyst wall in treating adult type I choledochal cyst(CC).Methods:The medical re...Objective:To compare Roux-en-Y hepatico-jejunostomy with complete resection of the cyst or incomplete resection with 1-cm remnant proximal cyst wall in treating adult type I choledochal cyst(CC).Methods:The medical records of 267 adult patients with type I CC from January 1998 to December 2015 were reviewed retrospectively.Among them,171 underwent Roux-en-Y hepatico-jejunostomy with complete resection(PBD 0-cm group)and 96 underwent Roux-en-Y hepatico-jejunostomy with 1-cm proximal cyst wall left(PBD 1-cm group).The short-and long-termpost-operative complications were compared between the two groups.Results:No significant difference was observed in operative time or anastomotic diameter between the two groups.The incidence of perioperative complications was significantly higher in the PBD 1-cm group than that in the PBD 0-cm group(28.1%vs 14.0%,p¼0.005),especially post-operative cholangitis(7.3%vs 1.2%,p¼0.021).The incidence of long-term post-operative complications was not significantly different,including anastomotic stricture,reflux cholangitis,intra-hepatic bile duct stones and bile leak(all p>0.05).Post-operative intra-pancreatic biliary malignancy occurred in one patient in the PBD 0-cm group at 25 months and one patient in the PBD 1-cm group at 5 month,respectively.Anatomical site malignancy was observed in one patient in the PBD 1-cm group at 10 months.Conclusion:Ease of performing anastomosis does not justify retaining a segment of choledochal cyst in type I CC due to its higher risk of post-operative complication and malignancy.A complete excision of the CC with anastomosis to the healthy proximal bile duct is necessary in treatment of type I CC.展开更多
基金supported by grants from the Science&Technology Support Project of Sichuan Province(No.2014SZ0002–10 and No.2015FZ0076).
文摘Objective:To compare Roux-en-Y hepatico-jejunostomy with complete resection of the cyst or incomplete resection with 1-cm remnant proximal cyst wall in treating adult type I choledochal cyst(CC).Methods:The medical records of 267 adult patients with type I CC from January 1998 to December 2015 were reviewed retrospectively.Among them,171 underwent Roux-en-Y hepatico-jejunostomy with complete resection(PBD 0-cm group)and 96 underwent Roux-en-Y hepatico-jejunostomy with 1-cm proximal cyst wall left(PBD 1-cm group).The short-and long-termpost-operative complications were compared between the two groups.Results:No significant difference was observed in operative time or anastomotic diameter between the two groups.The incidence of perioperative complications was significantly higher in the PBD 1-cm group than that in the PBD 0-cm group(28.1%vs 14.0%,p¼0.005),especially post-operative cholangitis(7.3%vs 1.2%,p¼0.021).The incidence of long-term post-operative complications was not significantly different,including anastomotic stricture,reflux cholangitis,intra-hepatic bile duct stones and bile leak(all p>0.05).Post-operative intra-pancreatic biliary malignancy occurred in one patient in the PBD 0-cm group at 25 months and one patient in the PBD 1-cm group at 5 month,respectively.Anatomical site malignancy was observed in one patient in the PBD 1-cm group at 10 months.Conclusion:Ease of performing anastomosis does not justify retaining a segment of choledochal cyst in type I CC due to its higher risk of post-operative complication and malignancy.A complete excision of the CC with anastomosis to the healthy proximal bile duct is necessary in treatment of type I CC.
