先天性胆总管囊性扩张症的外科治疗(附145例报告)

目的　总结我院 3 5年外科治疗先天性胆总管囊性扩张症的经验。方法　对 1964～ 1999年共收治的 15 2例先天性胆总管囊性扩张症中接受手术治疗的 14 5例进行回顾性分析和随访。结果　 15 2例中未手术 7例 ,死亡 1例。手术治疗 14 5例 ,死亡 6例。 1岁以内出现症状、发生肝硬变和死亡例数比 1岁以上组高 (P<0 .0 5 )。单纯囊肿内引流术3 9例 (囊肿十二指肠吻合 5例、囊肿空肠Roux Y吻合 3 3例、囊肿胆囊吻合 1例 ) ,囊肿切除胆肠Roux Y吻合重建胆道10 6例 (胆支空肠袢套叠瓣或矩形瓣成形分别为 3 7例和 2 1例 ,48例未作抗返流瓣 )。获访 77例 ,平均 4.68年。获访病例生长发育良好。结论　该病早期手术肝损伤可逆转 ,预后良好 ,只要患儿能耐受应尽早选择囊肿切除胆肠Roux Y吻合套叠瓣成形胆道重建术

Surgical Treatment of Congenital Choledochal Cyst (Report of 145 Cases)

Objective To present the surgical treatment experiences of congenital choledochal cyst (CCC). Methods One hundred and forty five patients in 152 CCC were analyzed retrospectively and followed in west China hospital of Sichuan university from 1964 to 1999. Results One hundred and forty five cases underwent operation and 6 of them died after operation. The incidence of hepatocirrhosis within first year after birth is higher than those over one year old ( P < 0.05 ). Thirty nine cases underwent cystoduodenostomy or cystojejunostomy. One hundred and six children underwent cyst resection and biliary tract reconstruction (with single Roux Y hepaticojejunostomy 48 cases, intussusceptive valve and rectangular valve to the line of Roux Y hepaticojejunostomy 37 and 21 cases respectively). Seventy seven patients were followed up (means 4.68 years). Two of 3 cases with ascending cholangitis after single Roux Y hepaticojejunostomy underwent reoperations with an intussusceptive valve added to the line of Roux Y hepaticojejunostomy and the symptoms disappeared. All of them have a good outcome. Conclusion The younger the patients, the less severe the liver damaged, and its prognosis are better. The procedure that cyst resection totally and an intussusceptive valve added to the line of Roux Y hepaticojejunostomy should be carried out early as soon as possible.