摘要
目的探讨成人型胆管囊肿的临床特点和手术方式，总结胆管囊肿的诊治经验。方法回顾性分析19842007年北京协和医院收治的109例成人型胆管囊肿的病例，总结病例特点。109例中男女之比为1：3．8。平均年龄32．8岁。I型78例，Ⅳa型26例，V型5例，没有Ⅱ、Ⅲ型病例。结果成人型胆管囊肿临床表现以右上腹不适或疼痛占大多数，共100例（91．7％），其次为寒战、发热等发作性胆管炎症状。30例（27．5％）有过胆道系统手术史，26例初次手术在2000年前施行。B超结合MRCP是确诊的主要手段。94例行囊肿切除、肝管空肠Roux-Y吻合重建术，4例因肝内病变局限于左肝加做左肝外侧段切除术。4例囊肿恶变。无手术死亡病例。手术近期并发症有胰瘘、膈下脓肿。后期并发症主要是发作性胆管炎、吻合口狭窄和肝内胆管结石。结论成人型胆管囊肿的临床表现不典型，以右上腹痛或不适最为多见。B超是初查的主要手段，为明确诊断、了解胆管囊肿分型和累及范围可首选MRCP。胆管囊肿理想的手术方式是囊肿切除、肝管空肠RouwY吻合重建术。
Objective To discuss the diagnosis and treatment of congenital choledochal cyst （CCC）. Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed. The male： female ratio was 1 ： 3.8. The mean age was 32.8 years. Seventy eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ. There was no case of type Ⅱ or Ⅲ. Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations. Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000. B-US and MRCP were the primary methods for diagnosis after 2000. Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy. Four patients required the left lateral hepatectomy in addition. Four patients were testified malignant change by pathological examination. There were four pancreatic fistulas and two Subphrenic abscesses. There was no postoperative death. Forty six patients were available for follow-up. The late complications in- eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu la. Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients. B US and MRCP should be the prefered imaging methods for diagnosis. Complete excision of the extrahepatic cyst and hepaticojeju nostomy were ideal treatment.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2009年第6期453-456,共4页
Chinese Journal of Hepatobiliary Surgery
基金
基金项目：北京市重点学科基金资助项目（编号HK100230446）
关键词
胆管囊肿
诊断
外科治疗
Congenital choledochal cyst
Diagnosis
Treatment
